title: Disability index in a randomized controlled trial of emergency sclerotherapy versus portacaval shunt for bleeding varices in cirrhosis.
abstract: BACKGROUND
  Disability has not been studied after emergency treatment of bleeding esophageal varices (BEV). We created a disability index (DI) in a randomized controlled trial comparing emergency endoscopic therapy (EST) versus emergency portacaval shunt (EPCS).
  
  
  METHODS
  There were 211 unselected, consecutive patients with cirrhosis and acute BEV who were randomized to EST (n = 106) or EPCS (n = 105). Diagnostic work-up and treatment were performed within 8 hours. Ninety-six percent underwent more than 10 years follow-up evaluation. Disability was measured by assessing 9 factors to create a DI.
  
  
  RESULTS
  Ten-year survival was 8% after EST versus 51% after EPCS (P < .001). EPCS had a significantly better DI. The EST and EPCS values were as follows: liver function improvement: not applicable and ++; worsening liver function, ++ and not applicable; portal-systemic encephalopathy (PSE) incidence, 36 and 15; PSE episodes, 179 and 94; packed red blood cell units, 1,005 and 320; hospital readmissions, 387 and 292; and number of readmission days, 9.6 and 4.7. All of the P values were less than .001.
  
  
  CONCLUSIONS
  EPCS resulted in a markedly better DI than EST, a significantly higher survival rate, better control of bleeding, and a lower incidence of PSE. EPCS is an effective first-line emergency treatment of BEV.
authors.affiliation: Department of Surgery, University of California San Diego Medical Center, 200 West Arbor Dr., San Diego, CA 92103-8999, USA. orloffs@ohsu.org
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: D004185:Disability Evaluation; D004630:Emergencies; D016099:Endoscopy, Gastrointestinal; D017707:Erythrocyte Transfusion; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006501:Hepatic Encephalopathy / Q000453:epidemiology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000401:mortality; D010359:Patient Readmission / Q000706:statistics & numerical data; D011167:Portacaval Shunt, Surgical; D015911:Sclerotherapy; D012720:Severity of Illness Index; D014654:Vascular Patency