Endoscopic sclerotherapy versus esophageal transection of Child's class C patients with variceal hemorrhage. Comparison with results of portacaval shunt: preliminary report

Abstract

Thirteen Child's class C patients with variceal hemorrhage requiring 6 or more units of blood were randomly assigned to groups receiving either flexible endoscopic sclerotherapy using 5% sodium morrhuate or esophageal transection/reanastomosis employing the EEA Auto Suture stapling instrument. One patient with a previous hiatus hernia repair was assigned to the transection group and had a mesocaval shunt. The randomization groups compared favorably with each other and with a retrospective shunt group (20 patients). Although transection patients required significantly less operative time and fewer blood transfusions, the outcome of the transection group was significantly worse than that of the shunt group. The trend in survival likewise favored the shunt group rather than the sclerotherapy group. Although the reported operative mortality rates of transection and sclerotherapy are less than that of portal decompression, the results of this study--the first controlled trial of these procedures--would warrant distinct caution in using either of these new techniques in high-risk patients. Portal decompression may still be the procedure of choice in class C patients with substantial variceal hemorrhage.