[Treatment of bleeding esophageal varices: sclerotherapy or surgery?]

To evaluate therapeutic options to improve the prognosis of haemorrhage from oesophageal varices, a study was performed on 422 patients observed from 1983 to 1998. Patients were classified according Child-Campbell method after improvement of general conditions (class A: 7%; B: 68%; C: 25%). Thirty-two patients (7.8%) died during emergently pharmacologic treatment in the first 24 hours; 182 patients (44.6%) because of persistent haemorrhage underwent endoscopic sclerotherapy. In 164 (90.1%) bleeding stopped and 14 cases (7.6%) underwent emergency surgical treatment (9 splenectomies and splenorenal shunts, 5 mesenterico-caval shunts). Teu other patients (with rebleeding 3-7 days after sclerotherapy) underwent emergency surgical treatment (7 azygos-portal thoracotomic deconnections, 3 splenectomies and spleno-renal shunts). The rates of therapeutic success were respectively 80% for surgical treatment and 90% after sclerotherapy. Factors of prognostic improvement of these emergently disease are examined. The advantages of both endoscopic and surgical treatment are outlined.