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Sclerotherapy of bleeding esophageal varices using a thrombogenic cocktail
R Nakamura1, L A Bucci, C Sugawa
1Department of Surgery, Wayne State University, School of Medicine, Detroit, Michigan 48201.
Insights
This study on esophageal varices found that thrombogenic sclerotherapy effectively controlled bleeding in most patients. Long-term survival depended on adherence to follow-up treatments and alcohol abstinence.
Area of Science:
- Gastroenterology
- Hepatology
- Vascular Surgery
Background:
- Esophageal varices are a common complication of advanced liver disease, particularly alcoholic cirrhosis.
- Bleeding from esophageal varices carries a high mortality risk.
- Effective management strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the short- and long-term efficacy and safety of a thrombogenic sclerosant mixture for esophageal varices.
- To identify factors influencing patient survival after sclerotherapy.
Main Methods:
- A prospective study involving 101 patients with esophageal varices, predominantly those with alcoholic cirrhosis (Child's C).
- Treatment involved sclerotherapy using a thrombogenic agent (1% tetradecyl sulfate, thrombin, and cefazolin).
- Patients were followed for up to 16 months to assess survival and treatment compliance.
Main Results:
- Initial bleeding control was achieved in 94% of patients with the first sclerotherapy session.
- In-hospital and 6-week mortality rates were 14% and 19%, respectively, correlating with hepatic disease severity.
- Long-term survival was significantly better in patients compliant with follow-up sclerotherapy (5% vs. 24%) and those abstaining from alcohol (6% vs. 23%).
- No systemic thrombotic or allergic events were observed with bovine thrombin.
Conclusions:
- Thrombogenic sclerotherapy is an effective method for controlling esophageal variceal bleeding.
- Patient adherence to follow-up sclerotherapy and alcohol abstinence are critical determinants of long-term survival.
- The sclerosant agent demonstrated a favorable safety profile.
Abstract:
The short- and long-term efficacy of a thrombogenic sclerosant (1% tetradecyl sulfate, thrombin, and cefazolin) was studied in 101 patients. The majority of patients had alcoholic cirrhosis with Child's C classification (84/101). Bleeding was controlled in 94 per cent of patients with the first sclerotherapy. In-hospital and early (within 6 weeks) mortality were 14 per cent and 19 per cent, respectively. There was a strong correlation with hospital mortality and the severity of hepatic disease. Long-term follow-up in 70 patients (mean of 16 months) showed that survival correlated with compliance to follow-up sclerotherapy and abstention from further alcohol intake. Mortality in patients compliant with follow-up was 5 per cent (1/19), as compared with 24 per cent (12/51) in patients who were not compliant with follow-up sclerotherapy. The mortality in alcoholic cirrhotic patients who abstained from further alcoholic intake was 6 per cent (1/17), as compared with 23 per cent (10/44) in those who continued to abuse alcohol. No systemic thrombotic or allergic events related to the use of bovine thrombin were noted during a total of 349 sclerotherapy sessions.