Skip to main content
Article thumbnail
Location of Repository

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

By Dinesh K. Bhargava, S. Dasarathy and Sushma Saksena

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

Topics: Research Article
Publisher: Hindawi Publishing Corporation
OAI identifier: oai:pubmedcentral.nih.gov:2362538
Provided by: PubMed Central
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://www.pubmedcentral.nih.g... (external link)
  • Suggested articles

    Citations

    1. (1992). A prospective randomised trial comparing repeated endoscopic sclerotherapy vs propranolol in poor risk cirrhotic patients. Hepatology
    2. Ammonia tolerance in the diagnosis of esophageal varices: a comparison of endoscopic, radiological and biochemical techniques.
    3. (1990). Comparative efficacy of emergency endoscopic sclerotherapy for active variceal bleeding due to cirrhosis of the liver, non-cirrhotic portal fibrosis and extrahepatic portal venous obstruction.
    4. (1989). Controversies in the management of bleeding esophageal varices.
    5. (1991). Efficacy of endoscopic sclerotherapy on long term management of esophageal varices: a comparative study of results in patients with cirrhosis of the liver, non-cirrhotic portal fibrosis and extrahepatic portal venous obstruction.
    6. (1986). Endoscopic sclerotherapy for esophageal varices using absolute alcohol.
    7. Endoscopic sclerotherapy for portal hypertension due to extrahepatic obstruction: results and long term follow-up.
    8. Endoscopic sclerotherapy of bleeding esophageal varices. A comparative study of results in patients with schistosomiasis and cirrhosis.
    9. Esophageal stricture and dysphagia after endoscopic sclerotherapy for bleeding varices.
    10. Incidence and management of complications after injection sclerotherapy: A 10 years prospective evaluation.
    11. (1989). Long term injection sclerotherapy treatment for esophageal varices: a 10 years prospective evaluation. Ann Surg
    12. Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate.
    13. (1992). Prospective randomized comparison ofsodium tetradecyl sulfate and polidocanol as variceal sclerosing agents.
    14. Role of endoscopic variceal sclerotherapy in the long term management of variceal bleeding: A meta-analysis.
    15. Sclerotherapy after variceal hemorrhage in non-cirrhotic portal fibrosis.
    16. The causes, management and outcome of upper gastrointestinal haemorrhage in an Indian Hospital.
    17. Transection of the oesophagus for bleeding esophageal varices.

    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.