[Treatment of hemorrhage caused by rupture of esophageal varices in the cirrhotic patient: remote results of a practical controlled study comparing the esophageal clip to conventional medical treatment].
From 1974 to 1979, a prospective controlled study was conducted in 100 patients with cirrhosis and bleeding esophageal varices. The patients were randomly allocated to either portal disconnection of the esophagus with a clip or medical treatment. Randomization and treatment were performed in emergency situation for 50 patients and electively in 50 patients. All survivors had at least 5 years of observation after randomization. Concerning rebleeding, in the group randomized in emergency, 33 p. cent of patients had recurrent bleeding in the surgical group (mean delay: 64.1 +/- 12.4 months) and 84 p. cent among the medically treated patients (mean delay: 10.6 +/- 4.7 months). This difference is statistically significant (p less than 0.001). For the group randomized electively, 25 p. cent of the surgical patients had recurrent bleeding (mean delay: 76.3 +/- 6.4 months) and 92 p. cent of the medically treated patients had recurrent haemorrhage (mean delay: 20 +/- 5.9 months). The difference is statistically significant p less than 0.001). Concerning survival, among the patients randomized in emergency, 20 died in the surgical group (mean survival: 38.9 +/- 9.3 months) and 22 in the medical group (mean survival: 10.8 +/- 4.6 months). Among the patients randomized electively, there were 19 deaths in the surgical group (mean survival: 46.6 +/- 6.8 months) and 21 in the medical group (mean survival: 32.2 +/- 7.6 months). The difference of survival between the medical and the surgical group is not statistically significant.
Prioton
J B
JB
Service de Chirurgie Viscérale, Hôpital Lapeyronie, Montpellier.
Feneyrou
B
B
Daures
J P
JP
Michel
H
H
Bories
P
P
Blanc
F
F
D000368:Aged; D002423:Cause of Death; D002986:Clinical Trials as Topic; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D004947:Esophagus / Q000098:blood supply; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation; D012422:Rupture, Spontaneous
Traitement des hémorragies par rupture de varices oesophagiennes chez le cirrhotique: résultats à distance d'une étude contrôlée pragmatique comparant le clip oesophagien au traitement médical conventionnel.