A comparative study of the elective treatment of variceal hemorrhage with beta-blockers, transendoscopic sclerotherapy, and surgery: a prospective, controlled, and randomized trial during 10 years.
OBJECTIVE
To compare three options for the elective treatment of portal hypertension during a 10-year period.


METHODS
Patients included in the trial were 18 to 76 years old, had a history of bleeding portal hypertension, and had undergone no prior treatment. Treatment options were beta-blockers (propranolol), sclerotherapy, and portal blood flow-preserving procedures (selective shunts and the Sugiura-Futagawa operation).


RESULTS
A total of 119 patients were included: 40 in the pharmacology group, 46 in the sclerotherapy group,and 33 in the surgical group. The three groups showed no differences in terms of age, Child-Pugh classification, and cause of liver disease. The rebleeding rate was significantly lower in the surgical group than in the other two groups. The rebleeding rate was only 5% in the Child A surgical group, compared with 71% and 68% for the sclerotherapy and pharmacotherapy groups, respectively. Survival was better for the low-risk patients (Child A) in the three groups, but when the three options were compared, no significant difference was found.


CONCLUSIONS
Portal blood flow-preserving procedures offer the lowest rebleeding rate in low-risk patients undergoing elective surgery.
Orozco
H
H
Instituto Nacional de la Nutrición, Salvador Zubirán, Mexico City, Mexico.
Mercado
M A
MA
Chan
C
C
Guillén-Navarro
E
E
López-Martínez
L M
LM
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000627:therapeutic use*; D011446:Prospective Studies; D015911:Sclerotherapy / Q000379:methods; D013997:Time Factors; D014648:Varicose Veins / Q000209:etiology* / Q000628:therapy*
D000319:Adrenergic beta-Antagonists; D011433:Propranolol