Sclerotherapy of bleeding esophageal varices using a thrombogenic cocktail.
The short- and long-term efficacy of a thrombogenic sclerosant (1% tetradecyl sulfate, thrombin, and cefazolin) was studied in 101 patients. The majority of patients had alcoholic cirrhosis with Child's C classification (84/101). Bleeding was controlled in 94 per cent of patients with the first sclerotherapy. In-hospital and early (within 6 weeks) mortality were 14 per cent and 19 per cent, respectively. There was a strong correlation with hospital mortality and the severity of hepatic disease. Long-term follow-up in 70 patients (mean of 16 months) showed that survival correlated with compliance to follow-up sclerotherapy and abstention from further alcohol intake. Mortality in patients compliant with follow-up was 5 per cent (1/19), as compared with 24 per cent (12/51) in patients who were not compliant with follow-up sclerotherapy. The mortality in alcoholic cirrhotic patients who abstained from further alcoholic intake was 6 per cent (1/17), as compared with 23 per cent (10/44) in those who continued to abuse alcohol. No systemic thrombotic or allergic events related to the use of bovine thrombin were noted during a total of 349 sclerotherapy sessions.
Nakamura
R
R
Department of Surgery, Wayne State University, School of Medicine, Detroit, Michigan 48201.
Bucci
L A
LA
Sugawa
C
C
Lucas
C E
CE
Gutta
K
K
Sugimura
Y
Y
Sferra
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D002437:Cefazolin / Q000627:therapeutic use; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012008:Recurrence; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D012981:Sodium Tetradecyl Sulfate / Q000627:therapeutic use; D013917:Thrombin / Q000627:therapeutic use*
D013917:Thrombin; D002437:Cefazolin; D012981:Sodium Tetradecyl Sulfate