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We read with interest the article by Ibrahim et al, which describes a randomised controlled trial (RCT) of early endoscopy with Hemospray within 2 hours of admission versus ‘early elective endoscopy’ at 12–24 hours for acute variceal bleeding (AVB).1
We would like to make comments that relate to the internal and external validities of the study. The article indicates that participants consented and were randomised following admission with suspected AVB on the basis of probable underlying liver cirrhosis and fresh blood on nasogastric lavage. However, the article also described how 19 patients were excluded from the trial at endoscopy before randomisation. As the intervention was to undergo an immediate …
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