[Prevention of recurrent hemorrhage caused by the rupture of esophageal varices in cirrhotic patients. A controlled study of propranolol and clip ligation of the esophagus].
Among the various treatments of ruptured oesophageal varices two seem to be effective: oral propranolol therapy and ligation of the oesophagus on clip. In this controlled study these two methods were compared in a series of 55 patients hospitalized for ruptured oesophageal varices. After haemodynamic stability was obtained, the patients were allocated at random to either propranolol therapy (n = 28) or surgery (n = 27). Twenty-one per cent of these patients belonged to group C of Child's classification and 54 per cent to group A. The parameters studied were similar in both groups. Five patients were excluded from the study: 2 in the medical group when it appeared that propranolol was contra-indicated and 3 in the surgical group who died before the operation; however, these 5 patients were taken into account in a second statistical evaluation. Nineteen out the 26 patients under propranolol (73 per cent) had rebleeding (within the first 10 days in 3 cases). In the surgical group recurrent bleeding was observed in 4 out of the 24 patients (17 per cent), and 4 other patients died post-operatively. The difference in favour of the surgical group was highly significant (P less than 0.001), and it remained significant (P less than 0.05) when the 5 patients who could not be treated were included into the calculations. Cox's multivariate analysis showed that patients in Child's C group had a poorer prognosis.
Parelon
G
G
Clinique des Maladies de l'appareil digestif, Hôpital Saint-Eloi, Montpelier.
Guiry
P
P
Daures
J P
JP
Bories
P
P
Feneyrou
B
B
Ampelas
M
M
Bauret
P
P
Aubin
J P
JP
Prioton
J B
JB
Michel
H
H
D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000628:therapy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use*; D011897:Random Allocation; D012008:Recurrence
D011433:Propranolol
Prévention de la récidive hémorragique par rupture de varices oesophagiennes chez le cirrhotique. Etude contrôlée comparant le propranolol et la ligature de l'oesophage sur clip.