Long-Term Management of Esophageal Varices by Endoscopic Sclerotherapy (EST): A Review of 12 Years' Experience

Dinesh K Bhargava,Sushma Saksena,S Dasarathy

doi:10.1155/dte.2.211

Abstract

A total of 566 patients with variceal bleeding caused by cirrhosis of the liver, noncirrhotic portal fibrosis (NCPF) and extrahepatic portal venous obstruction (EHO) were treated by repeated endoscopic injection sclerotherapy. This decreased rebleeding was evidenced by a reduction in mean bleeding risk factor and transfusion requirement. Both the factors were significantly (P < 0.001) decreased in all three groups of patients. Rebleeding occurred before eradication in 27.7% of patients with cirrhosis, 24.3% of those with NCPF, and 11% of those with EHO. Significantly more patients with cirrhosis and NCPF bled in comparison to EHO. Irrespective of the etiology, fewer patients of Child's A class bled than those of Child's B and C classes (P < 0.001). The median bleeding-free period was longer in patients with EHO than in those with cirrhosis (P < 0.05). This period was also significantly longer in Child's A class than in Child's B and the latter had a longer median bleeding-free period than Child's C class (P < 0.01). Variceal eradication was achieved in 80% of patients with cirrhosis, 87% of patients with NCPF, and 90% of patients with EHO. The success of variceal eradication was higher in EHO patients in contrast with patients with cirrhosis of the liver. Similarly, eradication was better in Child's A class patients than in Child's B and C class patients. Recurrence of varices and complications were not influenced by the Child's status or etiology of portal hypertension. The probability of survival at 10 years was higher in patients with EHO (88%) and NCPF (80%) than in patients with cirrhosis (50%). Similarly, patients with Child's A (88%) status survived longer than those with Child's B (42%) status, and patients with Child's B status had a longer survival than Child's C status patients (0%). Thus, endoscopic variceal sclerotherapy appears to be a useful procedure for the long-term management of patients after an esophageal variceal bleeding irrespective of the etiology of portal hypertension.

Highlights

Since 1981, we have been injecting esophageal varices during active variceal bleeding and for long-term management after variceal bleeding [1,2,3,4]
The varices were caused by cirrhosis of the liver, noncirrhotic portal fibrosis (NCPF), and extrahepatic portal venous obstruction (EHO)
These are few studies on the long-term results of the use of endoscopic sclerotherapy (EST) for the management of patients who had bled from esophagastic varices as in the present study

Summary

Introduction

Since 1981, we have been injecting esophageal varices during active variceal bleeding and for long-term management after variceal bleeding [1,2,3,4]. Between 1981 and 1993, we treated 566 patients with portal hypertension, who had bleeding from esophageal varices. The varices were caused by cirrhosis of the liver, NCPF, and EHO. These are few studies on the long-term results of the use of endoscopic sclerotherapy (EST) for the management of patients who had bled from esophagastic varices as in the present study. The efficacy of this mode of treatment is retrospectively reviewed. This study compares the results among the three groups of patients. This is one ofthe largest groups ofpatients reported with a long and complete follow-up

Methods

Results

Conclusion