Treatment of bleeding oesophageal varices with endoscopic sclerotherapy--first results

Patients with bleeding oesophageal varices represent 5% of cases of upper GIT bleeding. Varices develop and bleed as a result of portal hypertension which is a complication occurring in 30% of patients who suffer from chronic liver diseases. The mortality rate for the first bleeding episode is 50% and 30% for subsequent episodes. Almost 100% of those who survive the first episode, bleed again within the following two years. The risk of rebleeding is higher with varices increasing their number, length and extension, varices of III and IV degrees, portal pressure over 16 mm Hg. Despite of some recent advances the endoscopic sclerotherapy still remains the initial treatment of choice in patients with bleeding oesophageal varices. Authors report of having achieved control over bleeding in 80 to 90% of patients. Over the next few days of the same hospitalisation 10 to 20% of those patients rebleed and require a second sclero-therapy session. When the latter fails in controlling the hemorrhage, the mortality rate is estimated as high as 100% which prompts more invasive surgical and radiological interventions.