Therapy

Perform sclerotherapy ^a within 6 hours ^b

Why?

• It reduces rebleeding and death ^a particularly if performed within 6 hours ^b
• It is more effective than balloon tamponade, though not clearly more effective than somatostatin ^a
• However complications are common - 18% of patients have severe complications from emergency sclerotherapy (bleeding from post-sclerosis ulcers, stenosis, oesophageal perforation) and of these 15% die. ^a

Sclerotherapy controls bleeding and reduces mortality

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
bleeding oesophageal varices a	sclerotherapy	sham	failure to control bleeding	40%	0.13 (0.05 to 0.36)	3 (3 to 5)
	sclerotherapy	sham	death	40%	0.39 (0.17 to 0.95)	5 (3 to 78)
	sclerotherapy	balloon tamponade	failure to control bleeding	40%	0.15 (0.04 to 0.53)	3 (4 to 10)

Early sclerotherapy reduces rebleeding

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
large bleeding oesophageal varices b	sclerotherapy within 6 hours	sclerotherapy after 24 hours	rebleeding at 12 months	34%	66% (14% to 87%)	4 (3 to 20)