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.
Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
M
M
Ohta
M
M
Hashizume
T
T
Kamakura
K
K
Ueno
M
M
Tomikawa
K
K
Tanoue
S
S
Kitano
K
K
Sugimachi
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