Sclerotherapy for actively bleeding esophageal varices in male alcoholics with cirrhosis

• Published in: Gastrointestinal endoscopy Vol. 46; no. 1; pp. 1 - 7
• Main Authors: Hartigan, Pamela M., Gebhard, Roger L., Gregory, Peter B.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.1997; Elsevier
• Subjects: Biological and medical sciences; Diseases of the digestive system; Medical sciences; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Human; Evaluation; Portal circulation disease; Alcoholism; Esophageal disease; Instrumentation therapy; Cardiovascular disease; Hepatic disease; Hemorrhage; Sclerotherapy; Venous disease; Esophagus; Vascular disease; Prospective; Cirrhosis; Randomization; Digestive diseases; Complication; Endoscopy; Comparative study; Varix
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/S0016-5107(97)70201-3

Background: Male alcoholics hospitalized with actively bleeding esophageal varices were treated with sclerotherapy or sham sclerotherapy and the outcomes during the index hospitalization were compared. Methods: The 87 patients were a subset of 253 patients enrolled in a prospective, randomized, single-blind, multicenter, controlled trial conducted in 12 VA medical centers. The patients (44 sclerotherapy, 43 sham therapy) were actively bleeding from esophageal varices at either randomization endoscopy (49) or follow-up endoscopy (38). Events and resource use during the index hospitalization were recorded. Results: In 40 (91%) of the sclerotherapy and 26 (60%) of the sham therapy patients, bleeding was stopped during the endoscopy session ( p < 0.001). During the hospitalization, 10 (25%) sclerotherapy and 21 (49%) sham therapy patients died ( p = 0.04, relative risk 2.17, 95% CI [1.02, 4.61]); 9 sclerotherapy and 22 sham therapy patients rebled ( p = 0.005). The median transfusion requirement was higher for sham therapy (8 vs 4 units, p = 0.001), the number of median ICU hours was greater (101 vs 55, p < 0.001), and more patients in this group required shunt surgery (6 vs 0, p = 0.01). Conclusion: Sclerotherapy, compared to no sclerotherapy, stops hemorrhage from actively bleeding esophageal varices and reduces use of resources. Sclerotherapy significantly increased hospital survival.(Gastrointest Endosc 1997;46:1-7)