Endoscopic injection sclerotherapy for esophageal varices in the elderly.
A group of 1127 patients who underwent sclerotherapy for esophageal varices were compared for outcome in terms of age: over and under age 70 years. Esophageal varices were completely eradicated in 81 of 110 patients > 70 years (73.6%) and in 791 of 1017 patients < 70 years (77.8%). Gastrointestinal bleeding after sclerotherapy occurred in 9 patients > 70 years (8.2%) and in 84 of those < 70 years (8.3%). Complications occurred in 16 patients > 70 years (14.5%) and in 141 < 70 years (13.9%). Liver failure and hepatoma accounted for more than 80% of the causes of death in both groups (80.3% versus 83.8%). The 5-year cumulative survival rates in patients with bleeding esophageal varices (bleeders) without hepatoma were 21.8% in those > 70 years and 58.7% in those < 70 years (p < 0.01), the relative survivals being 25.3% versus 66.6%. Patients without hepatoma and treated by prophylactic sclerotherapy accounted for 66.2% of patients > 70 years and 61.7% of those < 70 years, the relative survivals being 75.9% versus 71.9%. As analyzed by the Cox proportional-hazards model, age > 70 years was a prognostic factor in the bleeders (p < 0.01) but not in the nonbleeders. We recommend that elderly patients with esophageal varices be given prophylactic sclerotherapy, as the outcome for these patients is poor once bleeding has occurred.
Ohta
M
M
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Hashizume
M
M
Kamakura
T
T
Ueno
K
K
Tomikawa
M
M
Tanoue
K
K
Kitano
S
S
Sugimachi
K
K
D000368:Aged; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D004945:Esophagoscopy; D019856:Ethanolamine; D004983:Ethanolamines / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods; D008297:Male; D008875:Middle Aged; D012597:Sclerosing Solutions / Q000008:administration & dosage; D015911:Sclerotherapy
D004983:Ethanolamines; D012597:Sclerosing Solutions; D019856:Ethanolamine