Complications of sclerotherapy for esophageal varices in liver transplant candidates.

ENDOSCOPIC sclerotherapy as the initial form of therapy for bleeding esophageal varices is considered to be the treatment of choice in many centers. While bleeding is usually effectively controlled, \,2 the long-term prognosis for such patients remains poor3 ,4 since progressive hepatic deterioration often precipitated by the bleeding episode frequently leads to an early death. In an attempt to prevent the onset of future bleeding episodes in cirrhotic patients prophylactic sclerotherapy has become popular. The disappointing results of various prophylactic surgical procedures for bleeding varices have encouraged further the widespread use of prophylactic sclerotherapy. Nonetheless, recent randomized controlled studies have not supported the universal use ofprophylactic sclerotherapy.5,6 The advent of orthotopic liver transplantation (OLT) as an effective means of treating end-stage liver disease (ESLD) has altered the long-term prognosis for many cirrhotic patients. A recent report from this center has reported that sclerotherapy for bleeding varices followed by 0 L T significantly improved survival of cirrhotic patients. 3 The complications associated with sclerotherapy in potential liver transplant candidates and the effect of such complications on the outcome of OLT have not been addressed. This report indicates that sclerotherapy is associated with significant morbidity that can influence the outcome ofOLT.