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Vol 4, No 3 (2002)
Published online: 2002-11-08

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Endoscopic sclerotherapy in control of variceal hemorrhage: a prospective trial in nonselected cirrhotic patients

Maciej Gonciarz, Jacek Hartleb, Dariusz Gil, Aleksander Michalski, Jan Pruszowski, Jerzy Goniewicz, Anna Witiuk-Misztalska, Aldona Mularczyk, Włodzimierz Mazur, Michał Petelenz
Chirurgia Polska 2002;4(3):99-106.

Abstract

Background: Among many therapeutic regimens EVS (endoscopic variceal sclerotherapy) and EVL (endoscopic variceal ligation) are known to be the most effective treatments in variceal haemorrhage (75% to 95%) caused by liver cirrhosis.
The aim of this study was to determine the EVS efficacy in the eradication and treatment of bleeding oesophageal varices in patients who underwent endoscopic control in two months during follow-up.
Material and methods: Between 1991 and 2000 a total number of 271 patients of different cirrhosis aetiology (viral 63%, alcoholic 26%, AIH 3.7%, PBC 3%, cryptogenic 3.7%) underwent EVS procedure in two parts. In bleed the first, EVS was done in 3-day intervals up to variceal eradication (no more than 10 procedures) or up to EVS complications. In the cases of no variceal eradication, the second part of treatment was introduced (no more then 10 sclerotherapies). After that, the patients were endoscopically followed up for 48 months in two-month intervals. Retreatment using EVS was introduced if variceal recurrence was found.
Results: Acute haemostasis was achieved in 259 out of 271 patients (95.6%). Six patients died within the first 48 hours of hospitalisation. 131 patients were endoscopically followed up for 48 months regularly while the remaining 101 patients irregularly. 27 patients were lost, there was no information about them. Rebleeding occurred in 52 patients (22.5%). Rebleeding was noted in 32% of patients irregularly followed and in 16% regularly followed (p > 0.05). 77.5% of patients with rebleeding had no full variceal eradication.
Conclusion: EVS is very effective procedure in initial control of oesophageal variceal bleeding. It could also be effective in preventing of rebleeding if endoscopy and EVS are regularly performed in two-month intervals during follow-up.

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