Reviewer's report 
 Sclerotherapy for the primary prevention of bleeding from esophageal varices. A randomized Title: 
controlled multicentre trial. 
Authors: 
Dr Henk H.R. van Buuren ( vanbuuren@mdl.azr.nl )
Marijke M.C. Rasch ( wpkingma@worldonline.nl )
Piet P.L. Batenburg ( pl@batenburg.be )
Clemens C.J.M. Bolwerk ( cl.bolwerk@wxs.nl )
Jan J.J. Nicolai ( jjnicge@knmg.nl )
Sjoerd S.D.J. van der Werf ( sdjvdwerfmd@hotmail.com )
Joost J. Scherpenisse ( scherp@rdgg.nl )
Lidia L.R. Arends ( arends@epib.fgg.eur.nl )
Jan J. van Hattum ( vanhattum@cs.com )
Erik E.A.J. Rauws ( e.a.rauws@amc.uva.nl )
Solko S.W. Schalm ( schalm@mdl.azr.nl )
 1  28 Jan 2003 Version: Date: 
 Tilman Sauerbruch Reviewer: 
 A paper whose findings are important to those with closely related research interests Level of interest: 
 Accept after discretionary revisions Advice on publication: 
The authors investigated prophylactic endoscopic sclerotherapy against no treatment for the prevention 
of variceal bleeding. They did not find a beneficial effect of this regimen compared to nonspecific treatment with respect to bleeding rate or mortality and thereby confirm the current consensus that sclerotherapy should not be used for primary prevention of variceal bleeding. 
Assessment: 
This is a well-designed controlled randomized trial. The methods as well as the results are adequately 
described and discussed. The major drawback of the study, however, is that the objective of the study 
is rather outdated since nowadays neither endoscopic sclerotherapy nor nonactive treatment are primary treatment options for patients with high-risk varices. However, this aspect is discussed in the manuscript ("conclusions"). Therefore, this well designed prospective trial should be published. 
Publication allows to further validate meta-analyses on the role of prophylactic sclerotherapy. 
Prior to publication, some minor aspects should be clarified: 
The manuscript title should include the information that sclerotherapy has been compared to nonactive 
treatment. This point should also be clarified in the abstract ("nonactive treatment" instead of "medical regimen"). The exact definition of variceal bleeding that has been applied should be given (in accordance with 
Baveno consensus ?). 
If available, the co-medication should be described, particularly with respect to nitrates or beta-blockers. 
Was this equally distributed between the treatment groups ? 
The authors'names of the references 27, 37 and 39 are missing. 
Table 3: Other causes/unknown should be specified (e.g. in the table's heading). Table 4: Sclerotherapy complications in the control group ? Please explain. 
Competing interests: 
None declared. 
Reviewer's report 
 Sclerotherapy for the primary prevention of bleeding from esophageal varices. A randomized Title: 
controlled multicentre trial. 
Authors: 
Dr Henk H.R. van Buuren ( vanbuuren@mdl.azr.nl )
Marijke M.C. Rasch ( wpkingma@worldonline.nl )
Piet P.L. Batenburg ( pl@batenburg.be )
Clemens C.J.M. Bolwerk ( cl.bolwerk@wxs.nl )
Jan J.J. Nicolai ( jjnicge@knmg.nl )
Sjoerd S.D.J. van der Werf ( sdjvdwerfmd@hotmail.com )
Joost J. Scherpenisse ( scherp@rdgg.nl )
Lidia L.R. Arends ( arends@epib.fgg.eur.nl )
Jan J. van Hattum ( vanhattum@cs.com )
Erik E.A.J. Rauws ( e.a.rauws@amc.uva.nl )
Solko S.W. Schalm ( schalm@mdl.azr.nl )
 1  28 Jan 2003 Version: Date: 
 Tilman Sauerbruch Reviewer: 
 A paper whose findings are important to those with closely related research interests Level of interest: 
 Accept after discretionary revisions Advice on publication: 
The authors investigated prophylactic endoscopic sclerotherapy against no treatment for the prevention 
of variceal bleeding. They did not find a beneficial effect of this regimen compared to nonspecific treatment with respect to bleeding rate or mortality and thereby confirm the current consensus that sclerotherapy should not be used for primary prevention of variceal bleeding. 
Assessment: 
This is a well-designed controlled randomized trial. The methods as well as the results are adequately 
described and discussed. The major drawback of the study, however, is that the objective of the study 
is rather outdated since nowadays neither endoscopic sclerotherapy nor nonactive treatment are primary treatment options for patients with high-risk varices. However, this aspect is discussed in the manuscript ("conclusions"). Therefore, this well designed prospective trial should be published. 
Publication allows to further validate meta-analyses on the role of prophylactic sclerotherapy. 
Prior to publication, some minor aspects should be clarified: 
The manuscript title should include the information that sclerotherapy has been compared to nonactive 
treatment. This point should also be clarified in the abstract ("nonactive treatment" instead of "medical regimen"). The exact definition of variceal bleeding that has been applied should be given (in accordance with 
Baveno consensus ?). 
If available, the co-medication should be described, particularly with respect to nitrates or beta-blockers. 
Was this equally distributed between the treatment groups ? 
The authors'names of the references 27, 37 and 39 are missing. 
Table 3: Other causes/unknown should be specified (e.g. in the table's heading). Table 4: Sclerotherapy complications in the control group ? Please explain. 
Competing interests: 
None declared. 
Please review this paper.
user
Reviewer's report 
 Sclerotherapy for the primary prevention of bleeding from esophageal varices. A randomized Title: 
controlled multicentre trial. 
Authors: 
Dr Henk H.R. van Buuren ( vanbuuren@mdl.azr.nl )
Marijke M.C. Rasch ( wpkingma@worldonline.nl )
Piet P.L. Batenburg ( pl@batenburg.be )
Clemens C.J.M. Bolwerk ( cl.bolwerk@wxs.nl )
Jan J.J. Nicolai ( jjnicge@knmg.nl )
Sjoerd S.D.J. van der Werf ( sdjvdwerfmd@hotmail.com )
Joost J. Scherpenisse ( scherp@rdgg.nl )
Lidia L.R. Arends ( arends@epib.fgg.eur.nl )
Jan J. van Hattum ( vanhattum@cs.com )
Erik E.A.J. Rauws ( e.a.rauws@amc.uva.nl )
Solko S.W. Schalm ( schalm@mdl.azr.nl )
 1  28 Jan 2003 Version: Date: 
 Tilman Sauerbruch Reviewer: 
 A paper whose findings are important to those with closely related research interests Level of interest: 
 Accept after discretionary revisions Advice on publication: 
The authors investigated prophylactic endoscopic sclerotherapy against no treatment for the prevention 
of variceal bleeding. They did not find a beneficial effect of this regimen compared to nonspecific treatment with respect to bleeding rate or mortality and thereby confirm the current consensus that sclerotherapy should not be used for primary prevention of variceal bleeding. 
Assessment: 
This is a well-designed controlled randomized trial. The methods as well as the results are adequately 
described and discussed. The major drawback of the study, however, is that the objective of the study 
is rather outdated since nowadays neither endoscopic sclerotherapy nor nonactive treatment are primary treatment options for patients with high-risk varices. However, this aspect is discussed in the manuscript ("conclusions"). Therefore, this well designed prospective trial should be published. 
Publication allows to further validate meta-analyses on the role of prophylactic sclerotherapy. 
Prior to publication, some minor aspects should be clarified: 
The manuscript title should include the information that sclerotherapy has been compared to nonactive 
treatment. This point should also be clarified in the abstract ("nonactive treatment" instead of "medical regimen"). The exact definition of variceal bleeding that has been applied should be given (in accordance with 
Baveno consensus ?). 
If available, the co-medication should be described, particularly with respect to nitrates or beta-blockers. 
Was this equally distributed between the treatment groups ? 
The authors'names of the references 27, 37 and 39 are missing. 
Table 3: Other causes/unknown should be specified (e.g. in the table's heading). Table 4: Sclerotherapy complications in the control group ? Please explain. 
Competing interests: 
None declared. 
assistant