Sclerotherapy in Noncirrhotic Portal Fibrosis

Endoscopic sclerotherapy has emerged as aneffective and safe mode of treatment for long-termmanagement of esophageal varices due to cirrhosis ofliver and extrahepatic portal venous obstruction. There are few studies that have evaluated the role ofsclerotherapy in the management of esophageal varices inpatients with noncirrhotic portal fibrosis (NCPF). Wereport our results of long-term sclerotherapy in patients with NCPF. Seventy-two consecutivepatients (men 29, women 43; age 32.9 ± 11.8years) with recurrent variceal bleeding due to NCPF wereentered into the sclerotherapy program. Forty-eightpatients received intravariceal absolute alcohol and 24patients received intravariceal sodium tetradecylsulfate (STD). Variceal obliteration was achieved in 65(90.3%) patients with a mean of 5.7 ± 3.0 (range1-14) sessions. These patients were followed-up fora mean of 21.4 ± 20.4 (range 1-96) months.Thirteen (17.3%) patients had episodes of uppergastrointestinal bleeding during sclerotherapy. Rebleedafter obliteration was seen in 6 (9.2%) patients. Sclerotherapywas associated with a significant reduction in bleedingrate (bleeds per month per patient) during sclerotherapyand after obliteration of varices as compared to presclerotherapy period (P < 0.000001 forboth). Recurrence of esophageal varices afterobliteration was seen in 9 (13.9%) patients withreobliteration of varices in five patients in whomsclerotherapy was attempted. Complications includingesophageal ulcer and stricture formation were seen in 18(25%) and 4 (5.6%) patients respectively; strictureswere restricted to patients who received absolutealcohol. Two (2.77%) patients died of massive uppergastrointestinal bleed during follow-up. We concludethat sclerotherapy is an effective and safe modality inthe prevention of variceal bleeds in patients with NCPF.