[A comparative study among different therapeutic approaches to portal hypertension and bleeding esophageal varices]

Recurrence of haemorrhage in patients with portal hypertension is the most feared life-threatening complication and the one which most often conditions patient survival. The present study compares the results obtained in two groups of patients treated by surgery and endoscopic sclerotherapy, respectively, and a control group treated with traditional medical therapy during bleeding episodes and subsequently given no further treatment. The patients in each group were subdivided into three different risk classes on the basis of the Child classification. Patients treated surgically mainly belonged to Child classes A and B, whereas those treated by endoscopic sclerotherapy belonged to Child class C. The long-term survival results show no significant differences between the two groups. On the other hand, both groups show better survival data than the untreated patients. On the basis of the results obtained, the authors believe that surgical treatment appears to most indicated in patients belonging to the lower risk classes (Child A and B), whereas endoscopic sclerotherapy is better suited to patients belonging to the higher risk class (Child C).