[Emergency sclerotherapy in esophageal varices bleeding: prospective study in unselected patients with portal hypertension]

Abstract

Bleeding from esophageal varices is a serious life-threatening complication of portal hypertension. The aim of the study was to evaluate the efficacy and safety of endoscopic sclerotherapy in the emergency management of esophageal variceal bleeding and analysis of recurrent bleedings, complications and mortality within 6-week observation period.

Material and methods: Prospective study involved 128 unselected patients with portal hypertension, including 116 with liver cirrhosis and 12 with portal vein thrombosis, with active bleeding from esophageal varices, in age 20 to 83, mean 50.9. Twenty one patients were classified as Child-Pugh grade A, 43 as grade B and 64 as grade C. After confirmation of diagnosis by endoscopy, emergency scierotherapy procedures were performed according to strictly defined protocol.

Results: Active esophageal variceal bleeding was ceased in 123 out of 128 (96.1%) patients. Two patients with persisting bleeding were subjected to gastro-esophageal devascularisation and splenectomy. Three patients died of bleeding and liver insufficiency. Recurrent bleedings in 19 (14.8%) patients were successfully treated with repeated sclerotherapy procedures. Complications were found in 17 (13.3%) patients. During a 6-week observation period, 14 patients died, including 12 in Child-Pugh grade C.

Conclusions: Endoscopic sclerotherapy was proved to be an effective method of esophageal variceal bleeding management which allows to ceases hemorrhage in over 95% patients and reduced mortality rate to 11%. An important factor for achieving good results is experience of treating center.