title: Natural history of bleeding after esophageal variceal eradication in patients with extrahepatic portal venous obstruction; a 20-year follow-up.
abstract: BACKGROUND
  Long-term follow-up studies of patients with extrahepatic portal venous obstruction (EHPVO) after eradication of esophageal varices using endoscopic sclerotherapy (EST) are limited.
  
  
  METHODS
  Between 1985 and 1994, 223 patients with bleeding esophageal varices due to EHPVO underwent variceal eradication using EST. Regular annual clinical and endoscopic follow-up data were available for 198 of these patients for a mean period of 19.8 (range: 14-23) years. These data were analyzed retrospectively.
  
  
  RESULTS
  Of the 198 patients, 34 (17.2%) had rebleeding after variceal eradication. The mean duration from variceal eradication to recurrence of bleeding was 5.4 years. The causes of rebleeding were: recurrent esophageal varices in 21 patients, fundal varices in eight, portal gastropathy in three, and ectopic varices in two patients. Esophageal varices reappeared in 39 (19.7%) patients. Fundal varices appeared in 19 (9.5%) patients during follow-up.
  
  
  CONCLUSIONS
  EST is an effective treatment modality for bleeding esophageal varices due to EHPVO. During a follow-up of nearly 20 years after variceal eradication, only about one-sixth of the patients had recurrence of gastrointestinal bleeding. Bleeding was unusual after 10 years had passed since initial variceal eradication.
authors.affiliation: Department of Gastroenterology, Calicut Medical College, Calicut, 673 008, Kerala, India. drvarghesethomas@gmail.com
authors.forename: Varghese
authors.initials: V
authors.lastname: Thomas
authors.forename: Tony
authors.initials: T
authors.lastname: Jose
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques; D006504:Hepatic Veno-Occlusive Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D011169:Portal Vein; D012008:Recurrence; D012189:Retrospective Studies; D015911:Sclerotherapy; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult