Esophageal Varices In Cirrhosis Research Articles

The incidence esophageal varices in cirrhosis

The incidence esophageal varices in cirrhosis

The incidence of esophageal varices in cirrhosis

The incidence of esophageal varices in cirrhosis

Prognostic indicators of successful endoscopic sclerotherapy for prevention of rebleeding from oesophageal varices in cirrhosis: a long-term cohort study

Background. Although band ligation is now recommended for prevention of rebleeding from oesophageal varices in cirrhosis, sclerotherapy is still widely used. Patients submitted to chronic sclerotherapy undergo several endoscopies and experience a large number of serious complications. However, long-term outcome is poorly defined. Aims. To assess the clinical course and prognostic indicators of patients undergoing chronic sclerotherapy for prevention of variceal rebleeding as a basis for future evaluation of long-term band ligation outcome. Methods. Prospective cohort study prognostic analysis by the Cox proportional hazards model. Results. A total of 218 consecutive cirrhotic patients (37 Child class A, 154 B, 27 CJ were enrolled in the study. Varices were obliterated in 139 (64%) patients in a mean of 5 (±2.6) sessions and recurred in 58 139 (41.7%) within one year. A total of 132 (60%) patients experienced 283 rebleeding episodes and 73 (33%) died. Bleeding from oesophageal ulcers was the most serious complication causing 14% of all rebleeding episodes. Significant prognostic indicators of sclerotherapy outcome were: Child-Pugh class for variceal obliteration; gastric varices and platelet count for recurrence of varices; failure to obliterate varices, variceal size and gastric varices for rebleeding; blood urea nitrogen and failure to obliterate varices for death. Presence of gastric varices was the only prognostic indicator for death in the 79 patients not achieving variceal obliteration. A mean of 10 endoscopies and of 6 hospital admissions were needed per each patient with an estimated cost of US$ 7154 per patient during the first two years of therapy. Conclusions. Sclerotherapy is a very demanding and costly treatment, and is associated with frequent and serious side-effects. The probability of treatment failure is significantly higher in Child C patients with gastric varices. Alternative treatments should be considered for these patients.

Prevention of the recurrence of bleeding from oesophageal varices in cirrhosis : Propranolol versus oesophageal clip, a randomized trial

Prevention of the recurrence of bleeding from oesophageal varices in cirrhosis : Propranolol versus oesophageal clip, a randomized trial

Variceal pressure, measured at endoscopy, but not portal pressure correlates with the risk of bleeding from oesophageal varices in cirrhosis

Variceal pressure, measured at endoscopy, but not portal pressure correlates with the risk of bleeding from oesophageal varices in cirrhosis

Course of esophageal varices in cirrhosis, in the absence of portal decompression.

Course of esophageal varices in cirrhosis, in the absence of portal decompression.

Emergency treatment of bleeding esophageal varices in cirrhosis

Emergency treatment of bleeding esophageal varices in cirrhosis

The Fate of Esophageal Varices in Cirrhosis Following Surgical Portal Decompression

Success of surgical portal decompression in the treatment of esophageal varices secondary to cirrhosis must be measured largely in terms of prophy­ laxis against future hemorrhage. The thorough effectiveness of shunt opera­ tions in this regard among patients observed at this hospital has recently been reported. l The purely objective results of portal decompression, especially in its effect on esophageal varices themselves, are important, too, not only for theoretic reasons but also because the technical purpose of decompression of the portal system is to make varices disappear. 2 9 This report deals with the fate of varices in patients with cirrhosis, as judged by esophagoscopic measurement, following portacaval shunt and splenorenal shunt, and it compares the course of varices in cirrhotic patients with and without surgical shunt. MATERIAL AND METHODS Sixty-three patients, with cirrhosis proved in all cases by liver biopsy, have been followed by periodic esophagoscopic examinations for more than 11 weeks and as long as 63 months following surgical portal decompression for eso­ phageal varices (table 1). An end-to-side portacaval shunt had been made in 49 patients, and an end-to-side splenorenal shunt in 14 patients. The patients were Caucasian men, except for 13 women and 2 Negroes. At the time of operation the numbers of patients per age-decade, from the second decade through the seventh, were, respectively, 2, 19, 15, 19, 7, and 1. In addition to the preoperative esophagoscopic examinations, which averaged about 2 per patient, there were 182 esophagoscopic examinations to evaiuate the severity of varices following shunt. These evaluations were made at various postopera­ tive intervals, but the general plan was to carry out the examination after 1, 3, 6, and 9 months and at 6-month intervals thereafter. The actual times of examinations after the shunt are indicated in table 2. The control group consisted of 45 patients for whom shunt was recom­ mended but who refused operation or, in a few cases, whose referring doctors did not agree with the recommendation for shunt. All of these control patients were followed by esophagoscopy for at least 3 and as long as 51 months after

The management of esophageal varices in cirrhosis of the liver in the absence of gastrointestinal hemorrhage.

The management of esophageal varices in cirrhosis of the liver in the absence of gastrointestinal hemorrhage.