Endoscopic injection sclerotherapy for esophageal varices in cirrhotic patients without hepatocellular carcinoma: a comparison of longterm survival between prophylactic therapy and emergency therapy.
BACKGROUND
This study aimed to determine whether prophylactic endoscopic injection sclerotherapy prolonged survival in patients with esophageal varices complicated by liver cirrhosis in the absence of hepatocellular carcinoma, compared with emergency sclerotherapy.


METHODS
The subjects included 160 patients suffering from esophageal varices complicated by liver cirrhosis without hepatocellular carcinoma. Sixty-eight patients underwent emergency therapy for bleeding varices and the remaining 92 patients underwent prophylactic sclerotherapy. All subjects continued to receive therapy until the varices disappeared.


RESULTS
Five-year survival was significantly better in the prophylactic group compared with the emergency group. During the 5-year observation period, 20 of the 68 patients in the emergency group experienced rebleeding and 5 patients died as a result of rebleeding. These rates were significantly higher than those in the prophylactic group (1 of 9 patients with bleeding died among the 92 prophylactic sclerotherapy patients). Multivariate analysis showed that prophylactic therapy and Child's C hepatic function were significant factors for 5-year survival.


CONCLUSIONS
Prophylactic sclerotherapy for esophageal varices might be more effective in prolonging longterm survival of patients complicated by liver cirrhosis in the absence of hepatocellular carcinoma, compared with emergency sclerotherapy.
Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan.
Tomofumi
T
Ogusu
Ryuichi
R
Iwakiri
Hiroyuki
H
Sakata
Keiji
K
Matsunaga
Ryo
R
Shimoda
Kayoko
K
Oda
Kenichirou
K
Watanabe
Hibiki
H
Ootani
Atsushi
A
Kikkawa
Akifumi
A
Ootani
Seiji
S
Tsunada
Kazuma
K
Fujimoto
D000328:Adult; D000368:Aged; D004638:Emergency Treatment; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D005260:Female; D016558:Hemostasis, Endoscopic; D006801:Humans; D007267:Injections; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage; D011379:Prognosis; D012597:Sclerosing Solutions / Q000008:administration & dosage; D015911:Sclerotherapy; D015996:Survival Rate
D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate