[Prevention of hemorrhagic recurrence in cirrhotic patients. Is sclerotherapy better than propranolol?].
The effectiveness of oral propranolol and sclerotherapy in preventing recurrent bleeding after an endoscopically proven haemorrhage from oesophageal varices was compared in Pugh's grade B and C patients divided into two successive therapeutic groups. Group I patients (n = 32) were given oral propranolol, while sclerotherapy was performed in group II patients (n = 32), 23 of whom simultaneously received propranolol. There was no difference between groups I and II in the severity of the initial bleeding and liver failure (Groups I/II, B 19/18, C 13/14), in the withdrawal of alcohol (group I 25, group II 17) and in compliance with either treatment (group I 25, group II 27). Obliteration of the oesophageal varices was achieved in 69 p. 100 of group II patients within a median number of 4 courses and 46 days, and in 84 p. 100 of the patients of this group who survived for more than 3 months. One year after the beginning of treatment rebleeding had occurred in 43 p. 100 of either group I or group II patients. The 1-year survival rate was 72 p. 100 in group I and 62 p. 100 in group II (non significant). The causes of death were the same in both groups. Irrespective of the treatment assigned, death was 2.1 times more frequent (P = 0.02) and rebleeding was 1.2 time more frequent (P = 0.08) in grade C than in grade B patients.
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Service des Maladies du foie et de l'appareil digestif, Hôpital de Bicêtre, Le Kremlin-Bicêtre.
Buffet
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Fritsch
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Pelletier
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Honein
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Attali
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Etienne
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D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D012421:Rupture; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D013997:Time Factors
D012597:Sclerosing Solutions; D011433:Propranolol
Prévention de la récidive hémorragique chez les cirrhotiques. La sclérothérapie fait-elle mieux que le propranolol?