Endoscopic sclerotherapy of esophageal varices. Long-term follow-up, recurrence, and survival.
Academic Article
Overview
abstract
One hundred thirty-three patients (34.5% Child's C class) with at least one severe variceal hemorrhage and treated with repeated endoscopic sclerotherapy had a follow-up of 1-6 years (mean 20 months). The risk of rebleeding decreased significantly from 2 months after onset of sclerotherapy. Sixty-four patients (or 48%) rebled, within 2 months in 45 (70%). The incidence of rebleeding correlated with Child's category and with the size of the varices. The 2-month mortality rate was 28.6%; two-thirds died of severe rebleeding. Thirteen patients underwent emergency surgery for bleeding uncontrolled by sclerotherapy; nine of them died. Of the 120 treated only by sclerotherapy 93% ultimately died, 90% from variceal rebleeding. Mortality related to the liver disease was thus determined by rebleeding mainly within 2 months and by hepatic failure but not by etiology of the disease or number of previous hemorrhages. The more pronounced mortality in Child C versus B or A patients is thus due to early rebleeding and to more pronounced liver insufficiency in the early and later period. Varices could not be eradicated within 1 year by sclerotherapy in 9 patients; 68 of the 72 patients alive had total eradication, but recurrence of varices was observed in 19 (or 28%) within 1 year, independent of the etiology and severity of liver disease and varices. Only four patients rebled within 1 year, with no mortality. After 1-4 years, another five recurrences were noted, with two nonfatal bleeding episodes. This study argues for continuation of sclerotherapy until total eradication of varices as well as for regular follow-up to avoid recurrences.(ABSTRACT TRUNCATED AT 250 WORDS)
