title: Sclerotherapy for actively bleeding esophageal varices in male alcoholics with cirrhosis. Veterans Affairs Cooperative Variceal Sclerotherapy Group.
abstract: BACKGROUND
  Male alcoholics hospitalized with actively bleeding esophageal varices were treated with sclerotherapy or sham sclerotherapy and the outcomes during the index hospitalization were compared.
  
  
  METHODS
  The 87 patients were a subset of 253 patients enrolled in a prospective, randomized, single-blind, multicenter, controlled trial conducted in 12 VA medical centers. The patients (44 sclerotherapy, 43 sham therapy) were actively bleeding from esophageal varices at either randomization endoscopy (49) or follow-up endoscopy (38). Events and resource use during the index hospitalization were recorded.
  
  
  RESULTS
  In 40 (91%) of the sclerotherapy and 26 (60%) of the sham therapy patients, bleeding was stopped during the endoscopy session (p < 0.001). During the hospitalization, 10 (25%) sclerotherapy and 21 (49%) sham therapy patients died (p = 0.04, relative risk 2.17, 95% CI [1.02, 4.61]); 9 sclerotherapy and 22 sham therapy patients rebled (p = 0.005). The median transfusion requirement was higher for sham therapy (8 vs 4 units, p = 0.001), the number of median ICU hours was greater (101 vs 55, p < 0.001), and more patients in this group required shunt surgery (6 vs 0, p = 0.01).
  
  
  CONCLUSIONS
  Sclerotherapy, compared to no sclerotherapy, stops hemorrhage from actively bleeding esophageal varices and reduces use of resources. Sclerotherapy significantly increased hospital survival.
authors.forename: P M
authors.initials: PM
authors.lastname: Hartigan
authors.forename: R L
authors.initials: RL
authors.lastname: Gebhard
authors.forename: P B
authors.initials: PB
authors.lastname: Gregory
mesh_terms: D000437:Alcoholism / Q000150:complications; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000379:methods; D016037:Single-Blind Method; D016896:Treatment Outcome