Related Experiment Videos
Endoscopic esophageal sclerotherapy: long-term results of the elective procedure
A Russo1, A Magnano, G Passanisi
1University of Catania, Italy.
Insights
Chronic endoscopic sclerotherapy effectively prevents recurrent bleeding in cirrhotic patients with esophageal varices. This treatment significantly reduces bleeding risk after initial variceal hemorrhage, improving patient outcomes.
Area of Science:
- Gastroenterology
- Hepatology
- Endoscopic Procedures
Background:
- Esophageal varices are a common complication of portal hypertension in cirrhotic patients.
- Recurrent bleeding from esophageal varices carries a high mortality rate.
- Preventive strategies are crucial for managing patients with a history of variceal bleeding.
Purpose of the Study:
- To evaluate the efficacy of chronic elective endoscopic esophageal sclerotherapy in preventing recurrent variceal bleeding.
- To assess the impact of sclerotherapy on the bleeding risk index in cirrhotic patients.
Main Methods:
- A subgroup of 131 cirrhotic patients with portal hypertension and prior variceal bleeding underwent endoscopic sclerotherapy.
- Data from 74 patients with at least 6 months of follow-up after initial bleeding cessation were analyzed.
- Bleeding risk index was calculated and correlated with patient characteristics and treatment outcomes.
Main Results:
- 90.5% of patients had nonalcoholic portal hypertension.
- Recurrent varices developed in 60.8% of patients, with recurrent bleeding in 11.1%.
- The bleeding risk index decreased tenfold after sclerotherapy and correlated with prior hemorrhages and hepatic reserve.
Conclusions:
- Chronic elective endoscopic sclerotherapy is effective in preventing recurrent esophageal variceal bleeding.
- Sclerotherapy significantly reduces the bleeding risk index in cirrhotic patients.
- Endoscopic sclerotherapy should be considered a primary management strategy for patients with a history of variceal bleeding.
Abstract:
Chronic endoscopic esophageal sclerotherapy represents a primary technique for the prevention of recurrent bleeding in cirrhotic patients who have already experienced one variceal bleeding episode. 131 patients with portal hypertension and a history of esophageal variceal bleeding underwent endoscopic sclerotherapy. 74 of these patients constituted a subgroup which was singled out for special analysis. In these patients, treatment had been started after conservative management of an acute bleeding episode had stopped the bleeding and follow-up data for at least 6 months were available. 90.5% of these patients had nonalcoholic etiology for their portal hypertension. 60.8% of patients developed recurrent varices and 11.1% had recurrent bleeding from esophageal varices. The bleeding risk index, calculated as the number of hemorrhages/patient/months of follow-up, correlated strongly with the number of previous hemorrhages and inversely with hepatic reserve (Child's class). The bleeding risk index decreased tenfold after sclerotherapeutic obliteration of varices. These data suggest that chronic elective endoscopic sclerotherapy may play a primary role in the management of patients who have bled from esophageal varices.