Injection sclerotherapy for variceal bleeding in patients with irresectable hepatocellular carcinoma

Patients with cirrhosis and advanced hepatocellular carcinoma are seldom cured, and have limited survival. Bleeding from esophageal varices in such patients is a major complication which, if untreated, may be a terminal event. This study evaluated the efficacy of injection sclerotherapy in controlling acute bleeding from esophageal varices and the benefit of repeated injection to eradicate varices in patients with cirrhosis and irresectable hepatocellular carcinoma.

Between 1975 and 1997, nineteen of 688 patients (2.8%) treated for bleeding esophageal varices had cirrhosis and irresectable hepatocellular carcinoma. There were 13 men and 6 women; median age, 42 years (range: 20-81). Eight patients were Child's-Pugh grade B and 11 grade C; 11 patients were Okuda stage II and 8 stage III.

In 13 patients (68.4%) bleeding was controlled by injection sclerotherapy after a mean of 3 injections (range: 1-5), and of these esophageal varices were completely eradicated in 7 patients (53.9%), none of whom rebled. Twelve patients (63%) were discharged from hospital and had a mean survival of 100 days. Seven patients died in hospital, 5 of liver failure precipated by recurrent bleeding and 2 of hepatocellular carcinoma. Median survival for Child's-Pugh grade B patients was 80 days (range: 9-405) compared to 28 days (range: 8-117) for the grade C (P = 0.25).

Injection sclerotherapy controlled acute variceal bleeding in most patients with hepatocellular carcinoma and provided effective palliative therapy with no further bleeding after eradication of varices.