Combined sclerotherapy and operation for the treatment of bleeding oesophageal varices.
OBJECTIVE
To identify prognostic factors in a consecutive series of patients with bleeding oesophageal varices and develop an optimum regimen of treatment.


METHODS
Retrospective review.


METHODS
I Department of Surgery, University Hospital, Vienna, Austria.


METHODS
301 consecutive patients with bleeding oesophageal varices.


METHODS
Median survival and survival at one year after sclerotherapy alone (n = 213), or sclerotherapy with portosystemic shunt (n = 54), Hassab's devascularisation (n = 29), or liver transplantation (n = 5).


RESULTS
Prognosis was dependent on the severity of liver damage at the start of treatment. Median survival for Child's class A was 47 months, for Child's class B 54 months, and for Child's class C 2 months. The overall one year survival for patients in Child's class C was 33%, for sclerotherapy alone 28%, and for sclerotherapy and portosystemic shunt 42%, Hassab's devascularisation 50%, and liver transplantation 80%.


CONCLUSIONS
Despite the small number of patients who underwent liver transplantation and their poor initial prognosis (Child's class C, n = 4; class B, n = 1) our results suggest that liver transplantation should be considered for the treatment of patients with end stage cirrhosis and bleeding varices.
Függer
R
R
I. Chirurgische Universitätsklinik, University of Vienna, Austria.
Herbst
F
F
Mirza
D
D
Rogy
M
M
Steininger
R
R
Schulz
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011167:Portacaval Shunt, Surgical; D011379:Prognosis; D012008:Recurrence; D015911:Sclerotherapy / Q000295:instrumentation / Q000379:methods; D016019:Survival Analysis