A Prognostic Evaluation of Endoscopic Intravariceal Injection Sclerotherapy for Esophageal Varices

Overview

Journal Gastroenterol Jpn

Specialty Gastroenterology

Date 1989 Aug 1

PMID 2789159

Citations 2

Authors

M Ishida

H Masuyama

Affiliations

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Abstract

Eighty cases of endoscopic injection sclerotherapy for esophageal varices were retrospectively studied to evaluate their prognoses. These cases were evaluated in terms of post-therapeutic bleeding, survival rates and causes of death. Post-therapeutic bleeding occurred in 50% of the emergency cases (26 cases), 25% of the elective cases (16 cases) and 23.7% of the prophylactic cases (38 cases). The frequency of post-therapeutic bleeding was significantly lower in cases with variceal obliteration than in cases without obliteration. An evaluation of the survival rates by the Kaplan-Meier method revealed that poor prognostic factors in sclerotherapy cases were emergency cases, Child's C group, post-therapeutic cases with unsuccessfully obliterated varices, and cases with post-therapeutic bleeding. Concerning early death within 7 days after sclerotherapy, 4 emergency cases died from initial variceal bleeding despite sclerotherapy. Three of these 4 were hepatocellular carcinoma cases, and all 3 cases had tumor thrombi of the portal vein. We recommend prophylactic sclerotherapy from the standpoint of the prognosis after sclerotherapy. However, in the bleeding cases of hepatocellular carcinoma in Child's C group complicated by tumor thrombi of the portal vein, overly enthusiastic application of the therapy should be avoided.

Citing Articles

A case of Behçet's disease with occlusion of both caval veins and "downhill" esophageal varices.

Orikasa H, Ejiri Y, Suzuki S, Ishikawa H, Miyata M, Obara K J Gastroenterol. 1994; 29(4):506-10.

PMID: 7951863 DOI: 10.1007/BF02361251.

Sclerotherapy for esophageal variceal bleeding in advanced hepatocellular carcinoma: an 8-year experience in Taiwan.

Cheng C, Chen G, Chang C, Tseng C, Pan H, Huang C J Gastroenterol. 1994; 29(4):474-8.

PMID: 7951859 DOI: 10.1007/BF02361246.

References

Inoue R, Toyonaga A, Ohkubo K, Shimotsuura Y, Ohmagari K, Eguchi S . [Elective and prophylactic endoscopic injection sclerotherapy (EIS) in esophageal varices. Its influence on liver function with portographic and prognostic evaluation]. Nihon Shokakibyo Gakkai Zasshi. 1986; 83(3):669-78. View

JOHNSTON G, Rodgers H . A review of 15 years' experience in the use of sclerotherapy in the control of acute haemorrhage from oesophageal varices. Br J Surg. 1973; 60(10):797-800. DOI: 10.1002/bjs.1800601011. View

Kage M, Korula J, Harada A, Mucientes F, Kanel G, Peters R . Effects of sodium tetradecyl sulfate endoscopic variceal sclerotherapy on the esophagus. A prospective clinical and histopathologic study. J Clin Gastroenterol. 1987; 9(6):635-43. DOI: 10.1097/00004836-198712000-00006. View

Westaby D, MacDougall B, Williams R . Improved survival following injection sclerotherapy for esophageal varices: final analysis of a controlled trial. Hepatology. 1985; 5(5):827-30. DOI: 10.1002/hep.1840050520. View

Paquet K . Endoscopic paravariceal injection sclerotherapy of the esophagus--indications, technique, complications: results of a period of 14 years. Gastrointest Endosc. 1983; 29(4):310-5. DOI: 10.1016/s0016-5107(83)72642-8. View

MacDougall B, Westaby D, Theodossi A, Dawson J, Williams R . Increased long-term survival in variceal haemorrhage using injection sclerotherapy. Results of a controlled trial. Lancet. 1982; 1(8264):124-7. DOI: 10.1016/s0140-6736(82)90378-6. View

Terblanche J, Northover J, Bornman P, Kahn D, Barbezat G, Sellars S . A prospective evaluation of injection sclerotherapy in the treatment of acute bleeding from esophageal varices. Surgery. 1979; 85(3):239-45. View

Pomier-Layrargues G, Villeneuve J, Willems B, Huet P, Marleau D . Systemic and hepatic hemodynamics after variceal hemorrhage: effects of propranolol and placebo. Gastroenterology. 1987; 93(6):1218-24. DOI: 10.1016/0016-5085(87)90247-2. View

Benner K, Keeffe E, Keller F, Rosch J . Clinical outcome after percutaneous transhepatic obliteration of esophageal varices. Gastroenterology. 1983; 85(1):146-53. View

10.

Westaby D, MacDougall B, Melia W, Theodossi A, Williams R . A prospective randomized study of two sclerotherapy techniques for esophageal varices. Hepatology. 1983; 3(5):681-4. DOI: 10.1002/hep.1840030509. View

11.

Terblanche J, Bornman P, Kahn D, Jonker M, Campbell J, Wright J . Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding. A five-year prospective controlled clinical trial. Lancet. 1983; 2(8363):1328-32. DOI: 10.1016/s0140-6736(83)91090-5. View

12.

DiMagno E, Zinsmeister A, Larson D, Viggiano T, Clain J, Laughlin B . Influence of hepatic reserve and cause of esophageal varices on survival and rebleeding before and after the introduction of sclerotherapy: a retrospective analysis. Mayo Clin Proc. 1985; 60(3):149-57. DOI: 10.1016/s0025-6196(12)60211-0. View

13.

Koff R . Benefit of endoscopy in upper gastrointestinal bleeding in patients with liver disease. Dig Dis Sci. 1981; 26(7 Suppl):12S-16S. DOI: 10.1007/BF01300800. View

14.

Prindiville T, Miller M, Trudeau W . Prognostic indicators in acute variceal hemorrhage after treatment by schlerotherapy. Am J Gastroenterol. 1987; 82(7):655-9. View

15.

. Sclerotherapy after first variceal hemorrhage in cirrhosis. A randomized multicenter trial. N Engl J Med. 1984; 311(25):1594-600. DOI: 10.1056/NEJM198412203112502. View

16.

Santangelo W, Dueno M, Estes B, Krejs G . Prophylactic sclerotherapy of large esophageal varices. N Engl J Med. 1988; 318(13):814-8. DOI: 10.1056/NEJM198803313181304. View

17.

Inokuchi K . A selective portacaval shunt. Lancet. 1968; 2(7558):51-2. DOI: 10.1016/s0140-6736(68)92930-9. View

18.

Takase Y, Ozaki A, Orii K, NAGOSHI K, Okamura T, Iwasaki Y . Injection sclerotherapy of esophageal varices for patients undergoing emergency and elective surgery. Surgery. 1982; 92(3):474-9. View

19.

. The general rules for recording endoscopic findings on esophageal varices. Jpn J Surg. 1980; 10(1):84-7. DOI: 10.1007/BF02468653. View

20.

Lebrec D, Poynard T, Hillon P, Benhamou J . Propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a controlled study. N Engl J Med. 1981; 305(23):1371-4. DOI: 10.1056/NEJM198112033052302. View