[Endoscopic sclerotherapy versus propranolol after hemorrhage caused by rupture of esophageal varices in patients with cirrhosis. Results of a 4-year randomized study].
Between December 1982 and April 1987, we conducted a prospective randomized trial comparing the efficiency of endoscopic sclerotherapy with oral propranolol after variceal hemorrhage in cirrhosis. We present our results after a median follow-up of 3 years (range = 57-231 weeks). The sclerotherapy group (S) consisted of 28 patients and the propranolol group (P), 27 patients. The two groups were similar for age, sex, etiology and severity of liver disease, and severity of hemorrhage; the only difference concerned previous hemorrhages which were significantly more numerous in the S group. Sclerotherapy was performed with polidocanol 1 p. 100. A slow-release preparation of propranolol was used; the average daily dose was 160 mg. Eighteen patients in the S group had at least one hemorrhagic recurrence as opposed to 12 in the P group. This difference was not significant nor was the difference between actuarial curves of no-rebleeding (p = 0.30). No difference was noted concerning total deaths (15 in S versus 12 in P). Cumulative survival curves showed a non-significative difference (p = 0.99) percentages of survival in S and P groups were 75.0 p. 100 and 73.6 p. 100 at 1 year, 67.9 p. 100 and 64.6 p. 100 at 2 years, and 51.1 p. 100 and 52.7 p. 100 at 3 years respectively. Stratification according to Child's group, variceal size and history of variceal hemorrhage did not modify these results. However, male patients had less hemorrhagic recurrences with propranolol than after sclerotherapy. Length of hospitalization was not different in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Dollet
J M
JM
Service Hépato-Gastroentérologie, CHU de Nancy-Brabois, Vandoeuvre-lès-Nancy.
Champigneulle
B
B
Patris
A
A
Bigard
M A
MA
Gaucher
P
P
D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*; D011446:Prospective Studies; D011897:Random Allocation; D012008:Recurrence; D012422:Rupture, Spontaneous; D012597:Sclerosing Solutions / Q000627:therapeutic use*
D012597:Sclerosing Solutions; D011433:Propranolol
Sclérothérapie endoscopique contre propranolol après hémorragie par rupture de varices oesophagiennes chez le cirrhotique. Résultats à 4 ans d'une étude randomisée.