Table 4.

Control of Bleeding and Survival in Patients with Bleeding Esophageal Varices Randomized to Endoscopic Sclerotherapy or Emergency Portacaval Shunt

Variable	EST (n = 106)	EPCS (n = 105)	p Value
Control of bleeding, n (%)
Temporary during workup
Received vasopressin intravenously	95 (90)	80 (76)	0.012*
Bleeding at start of vasopressin infusion	47 (49)	55 (69)	0.014*
Bleeding decreased or stopped	36 (77)	38 (69)	0.51
Permanent by EST or EPCS
Indeterminate, nonbleeding death ≤14 d	4 (4)	12 (11)	0.040*
Successful control excluding indeterminates for at least
14 d	22 (21)	93 (100)	<0.001*
30 d	20 (20)	89 (100)	<0.001*
>30 d	20 (20)	89 (100)	<0.001*
Declaration of primary therapy failure, n (%)	81 (79)	0 (0)	<0.001*
Required ≥6 U PRBC in first 7 d	15 (19)	––
Required ≥8 U PRBC in any 12 mo	47 (58)	––
Recurrent variceal bleeding after variceal obliteration was declared	27 (33)	––
More than one criterion for failure	8 (10)	––
PRBC transfusion, U, mean/median (range)
Index hospitalization
Before primary therapy	4.5/4 (2–12)	5.8/5 (2–17)	<0.001*
During primary therapy	0.6/0 (0–7)	6.3/3 (0–68)	<0.001*
”Catch–up” after primary therapy	0.2/0 (0–4)	1.2/0 (0–21)	0.001*
Posttherapy bleeding
Variceal	4.4/0 (0–37)	0/0 (0–0)	<0.001*
Nonvariceal	0.3/0 (0–11)	1.8/0 (0–29)	0.059
Total PRBC units	10.0/7 (2–44)	15.0/10 (2–81)	<0.001*
Readmissions for bleeding
Variceal bleeding	6.8/2 (0–60)	0.4/0 (0–26)	<0.001*
Nonvariceal bleeding	3.8/0 (0–38)	3.5/0 (0–33)	0.23
Total PRBC units	10.6/7 (0–60)	3.9/0 (0–33)	<0.001*
Total PRBC units for variceal bleeding	15.8/14 (2–64)	13.6/10 (2–73)	0.037*
Overall survival (Pr/95% CI)			<0.001*
30–d	0.88 (0.82, 0.94)	0.87 (0.80, 0.93)
1–y	0.72 (0.64, 0.81)	0.81 (0.74, 0.89)
2–y	0.54 (0.45, 0.64)	0.77 (0.70, 0.86)
3–y	0.44 (0.36, 0.55)	0.75 (0.67, 0.84)
4–y	0.35 (0.27, 0.45)	0.74 (0.66, 0.83)
5–y	0.21 (0.14, 0.30)	0.73 (0.65, 0.82)
10–y	0.09 (0.05, 0.17)	0.46 (0.37, 0.56)
15–y	0.09 (0.05, 0.17)	0.46 (0.37, 0.56)
Median survival, y (95% CI)	2.48 (1.58, 3.76)	6.17 (5.60, 10.37)
Survival by Child’s risk class (Pr/95% CI)
5–y Child’s class (Pr/95% CI)
A	0.38 (0.24, 0.59)	0.89 (0.83, 1.00)	0.003*
B	0.15 (0.08, 0.30)	0.76 (0.64, 0.89)	<0.001*
C	0.11 (0.04, 0.31)	0.57 (0.41, 0.78)	0.005*
10–y Child’s class (Pr/95% CI)
A	0.18 (0.08, 0.38)	0.62 (0.45, 0.83)	0.003*
B	0.07 (0.02, 0.20)	0.45 (0.33, 0.61)	<0.001*
C	0.04 (0.01, 0.25)	0.33 (0.20, 0.55)	0.005*
Median survival, y (95% CI)
A	4.62 (4.08, 6.34)	10.43 (>5.92)	0.003*
B	2.61 (1.65, 3.96)	6.19 (>5.44)	<0.001*
C	0.58 (0.12, 2.36)	5.30 (0.70, 10.16)	0.005*
Survival by direct UCSD admission versus transfer from outside UCSD (Pr/95% CI)			0.48
Direct UCSD admission
5 y	0.17 (0.08, 0.36)	0.58 (0.42, 0.80)
10 y	0.11 (0.05, 0.29)	0.52 (0.27, 0.66)
Transfer from outside UCSD
5 y	0.24 (0.16, 0.36)	0.79 (0.70, 0.88)
10 y	0.08 (0.03, 0.18)	0.45 (0.36, 0.58)
Mean survival, y (95% CI)
Direct UCSD admission	2.71 (0.72, 4.51)	5.28 (>2.80)
Transfer from outside UCSD	2.45 (1.59, 3.76)	6.25 (5.81, 11.03)
Rescue portacaval shunt in EST group – effect on median survival, y (95% CI)
Successful EST (n = 21)	2.76 (1.52, 7.35)	—	0.48
Failed EST (n = 81)	2.71 (1.65, 3.92)	—
Rescue shunt–failed EST (n = 50)	3.01 (1.65, 4.34)	—	0.098
No rescue shunt–failed EST (n = 31)	2.36 (0.72, 4.34)	—
Overall survival: rescue shunt (n = 50) versus primary EPCS (n = 105)	3.01 (1.65, 4.34)	6.18 (5.61, 10.38)	<0.001*
Postoperative survival: rescue shunt (n = 50) versus primary EPCS (n = 105)	1.99 (1.34, 3.73)	6.18 (5.61, 10.38)	<0.001*

^*Statistically significant difference.

EPCS, emergency portacaval shunt; EST, endoscopic sclerotherapy; Pr, probability; PRBC, packed red blood cells; UCSD, University of California, San Diego.