title: [Treatment of bleeding esophageal varices: sclerotherapy or surgery?].
abstract: To evaluate therapeutic options to improve the prognosis of haemorrhage from oesophageal varices, a study was performed on 422 patients observed from 1983 to 1998. Patients were classified according Child-Campbell method after improvement of general conditions (class A: 7%; B: 68%; C: 25%). Thirty-two patients (7.8%) died during emergently pharmacologic treatment in the first 24 hours; 182 patients (44.6%) because of persistent haemorrhage underwent endoscopic sclerotherapy. In 164 (90.1%) bleeding stopped and 14 cases (7.6%) underwent emergency surgical treatment (9 splenectomies and splenorenal shunts, 5 mesenterico-caval shunts). Teu other patients (with rebleeding 3-7 days after sclerotherapy) underwent emergency surgical treatment (7 azygos-portal thoracotomic deconnections, 3 splenectomies and spleno-renal shunts). The rates of therapeutic success were respectively 80% for surgical treatment and 90% after sclerotherapy. Factors of prognostic improvement of these emergently disease are examined. The advantages of both endoscopic and surgical treatment are outlined.
authors.affiliation: Istituto di Chirurgia Toracica e Cardiovascolare, Università degli Studi di Messina.
authors.forename: I E
authors.initials: IE
authors.lastname: Acri
authors.forename: A
authors.initials: A
authors.lastname: Carditello
authors.forename: M
authors.initials: M
authors.lastname: Monaco
authors.forename: B
authors.initials: B
authors.lastname: Mondello
authors.forename: F
authors.initials: F
authors.lastname: Spinelli
mesh_terms: D004932:Esophageal and Gastric Varices / Q000601:surgery / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000601:surgery / Q000628:therapy*; D006801:Humans; D015911:Sclerotherapy