title: Alcoholic versus nonalcoholic cirrhosis in a randomized controlled trial of emergency therapy of bleeding varices.
abstract: BACKGROUND
  It has been proposed that portal-systemic shunts be avoided in alcoholic cirrhotics because survival rate is allegedly lower in alcoholics than in nonalcoholics. We examined this issue in a randomized controlled trial.
  
  
  METHODS
  Two hundred eleven unselected, consecutive patients with cirrhosis and bleeding esophageal varices were randomized to endoscopic sclerotherapy (EST) (n = 106) or emergency portacaval shunt (EPCS) (105). Treatment was initiated within 8 h. EST failure was treated by rescue portacaval shunt (PCS). Ten-year follow-up was 96%.
  
  
  RESULTS
  Results strongly favored EPCS over EST (P < 0.001). Among EPCS patients, 83% were alcoholic and 17% nonalcoholic. Outcomes were (1) permanent control of bleeding 100% versus 100%; (2) 5-y survival 71% versus 78%; (3) encephalopathy 14% versus 19%; (4) yearly charges $38,300 versus $43,000.
  
  
  CONCLUSIONS
  EPCS results were similar in alcoholic and nonalcoholic cirrhotics. EPCS is an effective first line emergency treatment in all forms of cirrhosis, including alcoholic.
authors.affiliation: Department of Surgery, University of California, San Diego Medical Center, 200West Arbor Drive, San Diego, CA 92103-8999, USA. morloff@ucsd.edu
authors.forename: Marshall J
authors.initials: MJ
authors.lastname: Orloff
authors.forename: Jon I
authors.initials: JI
authors.lastname: Isenberg
authors.forename: Henry O
authors.initials: HO
authors.lastname: Wheeler
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Haynes
authors.forename: Horacio
authors.initials: H
authors.lastname: Jinich-Brook
authors.forename: Roderick
authors.initials: R
authors.lastname: Rapier
authors.forename: Florin
authors.initials: F
authors.lastname: Vaida
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hye
authors.forename: Susan L
authors.initials: SL
authors.lastname: Orloff
mesh_terms: D004638:Emergency Treatment / Q000191:economics; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015911:Sclerotherapy