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Are child's class C patients with acute variceal bleeding worth treating?
G W Johnston1, E F Spencer, F J Mullan
1Royal Victoria Hospital, Belfast, UK.
Insights
Early sclerotherapy for acute variceal bleeding in Child
Area of Science:
- Gastroenterology
- Hepatology
- Surgical Gastroenterology
Background:
- Acute variceal bleeding is a life-threatening complication in patients with advanced liver disease.
- Child's Class C liver disease indicates severe hepatic dysfunction, posing significant treatment challenges.
- Early intervention strategies are crucial for improving outcomes in these high-risk patients.
Purpose of the Study:
- To evaluate the efficacy and outcomes of early sclerotherapy for acute variceal bleeding in Child's Class C liver disease.
- To assess the survival rates and complications associated with sclerotherapy and other interventions.
Main Methods:
- Retrospective analysis of 102 patients with Child's Class C liver disease admitted with acute variceal bleeding between 1980 and 1989.
- Patients were treated with a policy of early sclerotherapy; some underwent urgent esophageal transection.
- Follow-up at a specialized Liver Clinic with a minimum of one year.
Main Results:
- Out of 98 treated patients, 90 received sclerotherapy with a 21% hospital mortality rate (19 deaths).
- Complications included recurrent bleeding, liver failure, and respiratory issues.
- One, five, and eight-year survival rates were 50%, 21%, and 13%, respectively, suggesting salvage is worthwhile.
Conclusions:
- Early sclerotherapy offers a viable treatment option for acute variceal bleeding in Child's Class C liver disease.
- Despite significant mortality, long-term survival is achievable, justifying continued management efforts.
- Further research into optimizing treatment strategies for this patient population is warranted.
Abstract:
In the ten year period January 1980 to December 1989, 102 patients with Child's Class C liver disease (Pugh's Modification) were admitted with acute variceal bleeding to one surgical unit with a policy of early sclerotherapy. There were 56 males and 46 females; the average age was 55 years (range 28-77). Fifty-three suffered from alcoholic cirrhosis. Four died before definitive treatment could be carried out, three from liver failure and one from uncontrolled bleeding. Of the remaining 98 patients, eight had urgent oesophageal transection with three deaths from hepatorenal failure; 90 had sclerotherapy with 19 hospital deaths, nine from recurrent bleeding, eight from liver failure often coupled with renal failure and two from respiratory complications. Of the 76 who survived to leave hospital, 52 received chronic injection sclerotherapy, 10 had elective oesophageal transection and 14 did not have further elective intervention for various reasons. Surviving patients have been followed up at a special Liver Clinic with minimum follow up of one year. Although no patient has yet survived ten years, the one, five and eight year survivals of 50%, 21% and 13% suggest that salvage of these patients is worthwhile.
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