title: Distal splenorenal shunt versus endoscopic sclerotherapy for long-term management of variceal bleeding. Preliminary report of a prospective, randomized trial.
abstract: This paper reports the preliminary results of a prospective randomized trial comparing endoscopic variceal sclerosis and distal splenorenal shunt (DSRS) in the management of patients with cirrhosis and variceal bleeding. Seventy-one patients have been entered; 36 have received sclerosis and 35 DSRS. Randomization of the study population was stratified on Child's A/B (56%) and Child's C (44%). Sixty-one per cent had alcoholic and 39% non-alcoholic cirrhosis. No patients have been lost to follow-up, which currently stands at a median of 26 months. Rebleeding occurred significantly (p less than 0.05) more frequently in patients in the sclerosis group (19 of 36: 53%) compared to DSRS (1 of 35: 3%), but only 11 of 36 (31%) were not controlled by further sclerosis and failed that therapy. Patients in whom sclerosis failed underwent surgery. Survival was significantly (p less than 0.01) improved in the sclerosis group (+ surgery in 31%), with an 84% 2-year survival compared to a 59% 2-year survival in the DSRS group. Portal perfusion was significantly (p less than 0.05) better maintained in the sclerosis (95%) compared to the DSRS (53%) group. Galactose elimination capacity improved significantly (p less than 0.05) in 21 patients successfully managed by sclerosis at 1 year and was significantly (p less than 0.01) better maintained in the sclerosis compared to DSRS group. The authors conclude that endoscopic sclerosis: has a higher rebleeding rate than DSRS, with one third of patients failing therapy from rebleeding; allows significant improvement in liver function when successful; and gives significantly improved survival in the management of variceal bleeding when backed up by surgical therapy for patients with uncontrolled rebleeding.
mesh_terms: D000208:Acute Disease; D001707:Biopsy, Needle; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy; D005500:Follow-Up Studies; D005690:Galactose / Q000652:urine; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D011170:Portasystemic Shunt, Surgical / Q000379:methods*; D011446:Prospective Studies; D011897:Random Allocation; D012008:Recurrence; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D013164:Splenorenal Shunt, Surgical / Q000379:methods*; D013997:Time Factors
chemical_list: D012597:Sclerosing Solutions; D005690:Galactose