title: Long-term results of endoscopic injection sclerotherapy in 602 patients with esophageal varices.
abstract: OBJECTIVE
  Endoscopic injection sclerotherapy (EIS) has been extensively applied world wide. There are few reports, however, addressing the long-term prognosis (>20 years), although more than two decades have elapsed since the introduction of EIS for esophageal varices. Therefore, the cases of EIS performed in the past 25 years were reviewed to evaluate the long-term results of this procedure.
  
  
  METHODS
  There were 602 patients who underwent EIS for esophageal varices between 1981 and 2005, involving a total of 1,964 applications of this procedure. The procedure begins by intravascular injection of 10-20 mL of 5% ethanolamine oleate. The long-term follow-up data were evaluated with primary reference to changes in esophageal varices, survival rate, bleeding rate, causes of death and re-bleeding.
  
  
  RESULTS
  In 188 patients with known final endoscopic findings, the gross morphologic status was F1 in 65 patients (34.6%) and F0 in 123 patients (65.4%), only 22 patients (11.7%) were positive for red color sign. The survival rate was 47.4% at 5 years, 25.9% at 10 years, and 13.9% at 15 years. Rebleeding occurred in 93 patients (15.4%). The bleeding rate was 22.9% at 5 years, 28.9% at 10 years, and 28.9% at 15 years. The causes of death were hepatic failure in 244 patients and hepatic cancer in 88 patients, 19 patients died as a result of bleeding from varices (4.8%), 3 patients who died due to therapeutic procedure of EIS.
  
  
  CONCLUSIONS
  Both the survival rate and rebleeding rate associated with EIS were comparable to those undergoing surgical treatment in patients whose clinical characteristics were matched. EIS is a minimally invasive treatment method that is considered to be an effective first-line treatment for esophageal varices.
authors.affiliation: Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan. narisu@dnh.twmu.ac.jp
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Naritaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimakawa
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Isohata
authors.forename: Shinichi
authors.initials: S
authors.lastname: Asaka
authors.forename: Souichi
authors.initials: S
authors.lastname: Konno
authors.forename: Minoru
authors.initials: M
authors.lastname: Murayama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Yoshimatsu
authors.forename: Shunichi
authors.initials: S
authors.lastname: Shiozawa
authors.forename: Takao
authors.initials: T
authors.lastname: Katsube
authors.forename: Kenji
authors.initials: K
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D002423:Cause of Death; D015897:Comorbidity; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage; D011379:Prognosis; D012597:Sclerosing Solutions / Q000008:administration & dosage; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate