title: Merits of prophylactic sclerotherapy for esophageal varices concomitant unresectable hepatocellular carcinoma: prospective randomized study.
abstract: BACKGROUND
  Several clinical studies of prophylactic therapy for esophageal varices have led to the conclusion that prophylactic therapy is of no value, and it is generally not accepted in the Western world. However, this is not the case in Japan. The present study evaluated the efficacy of prophylactic endoscopic injection sclerotherapy (EIS) in patients with unresectable hepatocellular carcinoma (HCC) and risky esophageal varices.
  
  
  METHODS
  Twenty-seven patients with 'likely-to-bleed' esophageal varices concomitant with unresectable HCC were randomly allocated to two groups. Thirteen patients underwent prophylactic EIS (EIS group), whereas the remaining 14 patients were observed conservatively (control group).
  
  
  RESULTS
  No bleeding from esophageal varices occurred in the EIS group during the entire period of this study, whereas in thecontrol group the cumulative bleeding rate was 44.8% in 6 months. Cumulative survival rates of patients in the EIS group and in the control group were 48.8% and 7.7% in 2 years, respectively. There was a statistically significant difference between the two groups in cumulative bleeding rate and survival rate (P < 0.01).
  
  
  CONCLUSIONS
  This prospective study demonstrated that prophylactic EIS could prolong the survival of the patients with esophageal varices concomitant with unresectable HCC. Prophylactic EIS for patients with unresectable HCC may be, in part, justified according to the present study.
authors: Departments of Surgery and Science, Kyushu University, Fukuoka, Japan; Departments of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Tomohiko
authors: T
authors: Akahoshi
authors: Morimasa
authors: M
authors: Tomikawa
authors: Norifumi
authors: N
authors: Tsutsumi
authors: Makoto
authors: M
authors: Hashizume
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D015552:Injections, Intralesional; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000008:administration & dosage*; D011446:Prospective Studies; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000008:administration & dosage; D015911:Sclerotherapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate
keywords: endoscopic injection sclerotherapy (EIS); esophageal varices; hepatocellular carcinoma (HCC); unresectable HCC