Usefulness of manometric assessment of varices in maintenance sclerotherapy. A controlled trial.
In a prospective controlled study, 68 patients undergoing maintenance sclerotherapy were randomized to have intravariceal sclerotherapy based on either manometric assessment (n = 35) or visual assessment (controls, n = 33) of varix patency. For manometric assessment, a perfused variceal needle punctured each variceal column and, if low pressures fluctuating with respiration were obtained, the varix was injected. Control patients had patent varices injected based on visual assessment alone. During a mean follow-up of 13 mo (range 4-16 mo), 1 manometrically assessed patient bled once (0.002 bleeds/patient month) and 7 visually assessed patients bled 14 times from varices (0.03 bleeds/patient-month) (p less than 0.05). Two and nine episodes of ulceration occurred in manometric and visually assessed patients, respectively, (p less than 0.05). Varices were obliterated (i.e., disappeared) in 11 patients undergoing manometric assessment and in 2 patients undergoing visual assessment (p less than 0.01). Comparing results of visual and manometric assessment within "manometric" patients showed a consistent 25% error rate in diagnosing patency or thrombosis by visual assessment. Manometric assessment of varices during maintenance sclerotherapy reduces rebleeding and ulceration to very low levels.
Hosking
S W
SW
Robinson
P
P
Johnson
A G
AG
D002986:Clinical Trials as Topic; D003951:Diagnostic Errors; D004935:Esophageal Diseases / Q000517:prevention & control; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006801:Humans; D008365:Manometry / Q000295:instrumentation* / Q000379:methods; D011897:Random Allocation; D012597:Sclerosing Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D013927:Thrombosis / Q000517:prevention & control; D014456:Ulcer / Q000517:prevention & control; D014792:Visual Acuity
D012597:Sclerosing Solutions