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. 1986 Jul;204(1):78–82. doi: 10.1097/00000658-198607000-00011

Follow-up of patients after variceal eradication. A comparison of patients with cirrhosis, noncirrhotic portal fibrosis, and extrahepatic obstruction.

S K Sarin, G Sachdev, R Nanda
PMCID: PMC1251226  PMID: 3729586

Abstract

One hundred one patients, 54 with cirrhosis of liver, 31 with noncirrhotic portal fibrosis (NCPF), and 16 with extrahepatic obstruction (EHO), were followed up at monthly intervals for a mean (+/- SD) period of 17.9 +/- 4.8 months after achieving total variceal eradication with endoscopic sclerotherapy. Recurrence of esophageal varices was seen in 19 (18.8%) patients, 12 with cirrhosis and seven with NCPF, within a mean (+/- SD) period of 5.7 +/- 1.6 months. No patient with EHO showed recurrence. Three (2.9%) patients rebled from the recurred varices. Mean (+/- SD) number of sclerotherapy sessions and the amount of absolute alcohol required for eradication of recurred varices were 1.6 +/- 0.8 and 3.6 +/- 1.8 ml, respectively. Dysphagia and esophageal stricture were present in 15 (14.9%) patients with nearly similar frequency in patients with cirrhosis, NCPF, and EHO. Dysphagia in four patients with stricture improved without dilatation. While there were no deaths in patients with NCPF and EHO, 11 patients with cirrhosis died. There was significant (p less than 0.01) improvement in the liver status of surviving patients with cirrhosis after variceal eradication. It can be concluded that variceal recurrence and rebleeding are not major problems after sclerotherapy. Sclerotherapy probably helps in spontaneous improvement of the liver status of surviving cirrhotics and reduces long-term morbidity and mortality of patients with NCPF and EHO.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alwmark A., Bengmark S., Börjesson B., Gullstrand P., Joelsson B. Emergency and long-term transesophageal sclerotherapy of bleeding esophageal varices. A prospective study of 50 consecutive cases. Scand J Gastroenterol. 1982 Apr;17(3):409–412. doi: 10.3109/00365528209182077. [DOI] [PubMed] [Google Scholar]
  2. Anand C. S., Tandon B. N., Nundy S. The causes, management and outcome of upper gastrointestinal haemorrhage in an Indian hospital. Br J Surg. 1983 Apr;70(4):209–211. doi: 10.1002/bjs.1800700407. [DOI] [PubMed] [Google Scholar]
  3. Cello J. P., Grendell J. H., Crass R. A., Trunkey D. D., Cobb E. E., Heilbron D. C. Endoscopic sclerotherapy versus portacaval shunt in patients with severe cirrhosis and variceal hemorrhage. N Engl J Med. 1984 Dec 20;311(25):1589–1594. doi: 10.1056/NEJM198412203112501. [DOI] [PubMed] [Google Scholar]
  4. Christensen E., Schlichting P., Fauerholdt L., Gluud C., Andersen P. K., Juhl E., Poulsen H., Tygstrup N. Prognostic value of Child-Turcotte criteria in medically treated cirrhosis. Hepatology. 1984 May-Jun;4(3):430–435. doi: 10.1002/hep.1840040313. [DOI] [PubMed] [Google Scholar]
  5. Clark A. W., Macdougall B. R., Westaby D., Mitchell K. J., Silk D. B., Strunin L., Dawson J. L., Williams R. Prospective controlled trial of injection sclerotherapy in patient with cirrhosis and recent variceal haemorrhage. Lancet. 1980 Sep 13;2(8194):552–554. doi: 10.1016/s0140-6736(80)91990-x. [DOI] [PubMed] [Google Scholar]
  6. Dave P., Romeu J., Messer J. Upper gastrointestinal bleeding in patients with portal hypertension: a reappraisal. J Clin Gastroenterol. 1983 Apr;5(2):113–115. doi: 10.1097/00004836-198304000-00004. [DOI] [PubMed] [Google Scholar]
  7. Howard E. R., Stamatakis J. D., Mowat A. P. Management of esophageal varices in children by injection sclerotherapy. J Pediatr Surg. 1984 Feb;19(1):2–5. doi: 10.1016/s0022-3468(84)80003-2. [DOI] [PubMed] [Google Scholar]
  8. Johnston G. W., Rodgers H. W. A review of 15 years' experience in the use of sclerotherapy in the control of acute haemorrhage from oesophageal varices. Br J Surg. 1973 Oct;60(10):797–800. doi: 10.1002/bjs.1800601011. [DOI] [PubMed] [Google Scholar]
  9. MacDougall B. R., Westaby D., Theodossi A., Dawson J. L., Williams R. Increased long-term survival in variceal haemorrhage using injection sclerotherapy. Results of a controlled trial. Lancet. 1982 Jan 16;1(8264):124–127. doi: 10.1016/s0140-6736(82)90378-6. [DOI] [PubMed] [Google Scholar]
  10. Maxwell A. E. Comparing the classification of subjects by two independent judges. Br J Psychiatry. 1970 Jun;116(535):651–655. doi: 10.1192/bjp.116.535.651. [DOI] [PubMed] [Google Scholar]
  11. Okuda K., Kono K., Ohnishi K., Kimura K., Omata M., Koen H., Nakajima Y., Musha H., Hirashima T., Takashi M. Clinical study of eighty-six cases of idiopathic portal hypertension and comparison with cirrhosis with splenomegaly. Gastroenterology. 1984 Apr;86(4):600–610. [PubMed] [Google Scholar]
  12. Paquet K. J. Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices -- a prospective controlled randomized trial. Endoscopy. 1982 Jan;14(1):4–5. doi: 10.1055/s-2007-1021560. [DOI] [PubMed] [Google Scholar]
  13. Sarin S. K., Nanda R., Kumar N., Vij J. C., Anand B. S. Repeated endoscopic sclerotherapy for active variceal bleeding. Ann Surg. 1985 Dec;202(6):708–711. doi: 10.1097/00000658-198512000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Sarin S. K., Sachdeva G. K., Nanda R., Vij J. C., Anand B. S. Endoscopic sclerotherapy using absolute alcohol. Gut. 1985 Feb;26(2):120–124. doi: 10.1136/gut.26.2.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Sørensen T., Burcharth F., Pedersen M. L., Findahl F. Oesophageal stricture and dysphagia after endoscopic sclerotherapy for bleeding varices. Gut. 1984 May;25(5):473–477. doi: 10.1136/gut.25.5.473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Terblanche J., Bornman P. C., Kahn D., Jonker M. A., Campbell J. A., Wright J., Kirsch R. Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding. A five-year prospective controlled clinical trial. Lancet. 1983 Dec 10;2(8363):1328–1332. doi: 10.1016/s0140-6736(83)91090-5. [DOI] [PubMed] [Google Scholar]
  17. Terblanche J. The long-term management of patients after an oesophageal variceal bleed: the role of sclerotherapy. Br J Surg. 1985 Feb;72(2):88–90. doi: 10.1002/bjs.1800720204. [DOI] [PubMed] [Google Scholar]
  18. Webb L. J., Sherlock S. The aetiology, presentation and natural history of extra-hepatic portal venous obstruction. Q J Med. 1979 Oct;48(192):627–639. [PubMed] [Google Scholar]
  19. Witzel L., Wolbergs E., Merki H. Prophylactic endoscopic sclerotherapy of oesophageal varices. A prospective controlled study. Lancet. 1985 Apr 6;1(8432):773–775. doi: 10.1016/s0140-6736(85)91444-8. [DOI] [PubMed] [Google Scholar]

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