Endoscopic therapy for bleeding esophageal varices improves the outcome of Child C cirrhotic patients.
OBJECTIVE
Bleeding from esophageal varices is one of the frequent severe complications arising in patients with liver cirrhosis. The management of esophageal varices is therefore important for patient survival. The purpose of this study was to clarify the predictive factors for mortality in patients with Child C cirrhosis presenting with variceal bleeding.


METHODS
A retrospective analysis of 77 Child C cirrhotic patients with bleeding from esophageal varices was conducted. All patients received endoscopic therapy. Twenty-nine patients received endoscopic variceal ligation, and 48 patients received endoscopic injection sclerotherapy or endoscopic injection sclerotherapy with ligation. Univariate and multivariate analyses of clinical data were performed to identify the prognostic factors for survival for these 77 patients.


RESULTS
Fifty-seven of 77 patients received endoscopic therapy within 24 h after variceal bleeding, and bleeding was controlled in 55 (96.5%). The remaining 20 patients received endoscopic therapy more than 24 h after bleeding. Higher bilirubin level and rebleeding were the predictive parameters for 6-week survival in the 77 patients, according to univariate and multivariate analysis. Higher bilirubin level, refractory ascites, and the presence of hepatocellular carcinoma were the predictive parameters for mortality in 77 patients as determined by multivariate analysis.


CONCLUSIONS
Endoscopic therapy was effective in controlling acute variceal bleeding of Child C cirrhotic patients. The prognosis of Child C stage patients presenting with variceal bleeding depended on the severity of liver damage and the presence of hepatocellular carcinoma.
Hori
Shinichiro
S
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.
Takaki
Akinobu
A
Okada
Hiroyuki
H
Fujiwara
Akiko
A
Takenaka
Ryuta
R
Makidono
Chiho
C
Shiratori
Yasushi
Y
D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015552:Injections, Intralesional; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality; D008297:Male; D016016:Proportional Hazards Models; D012597:Sclerosing Solutions / Q000008:administration & dosage; D015911:Sclerotherapy; D016019:Survival Analysis; D016896:Treatment Outcome
D012597:Sclerosing Solutions