Long-Term Management of Esophageal Varices by Endoscopic Sclerotherapy (EST): A Review of 12 Years' Experience.
A total of 566 patients with variceal bleeding caused by cirrhosis of the liver, noncirrhotic portal fibrosis (NCPF) and extrahepatic portal venous obstruction (EHO) were treated by repeated endoscopic injection sclerotherapy. This decreased rebleeding was evidenced by a reduction in mean bleeding risk factor and transfusion requirement. Both the factors were significantly (P < 0.001) decreased in all three groups of patients. Rebleeding occurred before eradication in 27.7% of patients with cirrhosis, 24.3% of those with NCPF, and 11% of those with EHO. Significantly more patients with cirrhosis and NCPF bled in comparison to EHO. Irrespective of the etiology, fewer patients of Child's A class bled than those of Child's B and C classes (P < 0.001). The median bleeding-free period was longer in patients with EHO than in those with cirrhosis (P < 0.05). This period was also significantly longer in Child's A class than in Child's B and the latter had a longer median bleeding-free period than Child's C class (P < 0.01). Variceal eradication was achieved in 80% of patients with cirrhosis, 87% of patients with NCPF, and 90% of patients with EHO. The success of variceal eradication was higher in EHO patients in contrast with patients with cirrhosis of the liver. Similarly, eradication was better in Child's A class patients than in Child's B and C class patients. Recurrence of varices and complications were not influenced by the Child's status or etiology of portal hypertension. The probability of survival at 10 years was higher in patients with EHO (88%) and NCPF (80%) than in patients with cirrhosis (50%). Similarly, patients with Child's A (88%) status survived longer than those with Child's B (42%) status, and patients with Child's B status had a longer survival than Child's C status patients (0%). Thus, endoscopic variceal sclerotherapy appears to be a useful procedure for the long-term management of patients after an esophageal variceal bleeding irrespective of the etiology of portal hypertension.
Bhargava
D K
DK
Department of Gastroenterology All India Institute of Medical Sciences New Delhi 110029 India.
Dasarathy
S
S
Saksena
S
S