Endoscopic sclerotherapy of oesophageal varices. A clinical study

Abstract

Haemorrhage from oesophageal varices is a serious and feared complication of liver cirrhosis. One hundred and five patients treated for their first major variceal haemorrhage (VH) 1976-1979 were reviewed. Conventional therapy in a material with 60% Child class C patients with alcoholic cirrhosis resulted in a 50% first bleeding and a 36% readmission mortality with a one year survival of 30%. The conclusion was that the management schedule could be improved and that endoscopic sclerotherapy (ST) should be further evaluated. Conservative therapy and the addition of emergency and serial ST was compared in a prospective controlled trial in 107 unselected patients with major VH. Two-thirds belonged to Child's class C and 90% had alcoholic cirrhosis. Initial control of VH was obtained in 90% of all patients and the admission mortality was about 30%. The causes of mortality were mainly VH in 50 conservatively treated patients and hepatic failure and to VH unrelated causes in the ST-group (57 patients). Supplementary ST, a median of 6 sessions, succeeded in eradication of the varices in 34 of the 41 ST-patients discharged, failure was due to early death or continued alcoholism. Varices recurred in 5 patients during a 2-year follow-up. The number of rebleeds per observation month was overall decreased 3.6 times in the ST-group, but the survival was not prolonged. The effect of initial and serial ST on the mediastinal portalsystemic collaterals was investigated prospectively in 26 patients by repeated selective percutaneous transhepatic portography (PTP) and endoscopy. PTP was performed immediately prior to, and just after the first ST, showing reduced or inhibited contrast filling of oesophageal varices delineated on the pre-ST films in three-fourth of the patients. In 21 patients, follow-up PTP was carried out a median of 8 months later, when the varices were eradicated by serial ST. In 17 patients PTP supported the endoscopic estimation of variceal eradication, one patient was found to have residual varices. These patients were followed for a year, two patients developed recurrent varices. This study showed that submucosal oesophageal varicose veins can be efficiently eradicated by serial ST with a low recurrence rate. Oesophageal necrosis with delayed perforation intervened in 4% of our ST-patients with fatal outcome. Complications were noted in 30% of the patients treated with ST, and were major in 18%, mainly ulcerations with bleeding and transmural necrosis. Strictures encountered in 15% of the patients were easily treated. Oesophageal manometry was performed in 31 patients.(ABSTRACT TRUNCATED AT 400 WORDS)