Ethanol thrombotherapy of esophageal varices: further experience

Fifty patients with liver cirrhosis (13 Child class B, 37 class C) were treated for variceal hemorrhage during a 3-year period using the transhepatic selective catheterization and injection of absolute ethanol. Technical failure of the procedure was encountered in 13 instances. The causes were the presence of massive ascites and rigidly contracted liver, cavernous transformation of the main portal vein, and severe coagulopathy. Of the 13 failures, 12 were in Child class C and one in class B. Of 37 initially successfully treated patients, 13 rebled subsequently. Nine of these were Child class C and four were class B. Rebleeding was fatal in five of nine class C patients. Rebleeding was due to recanalization of previously thrombosed access channel in two of 13 patients. Nine patients died, despite successful thrombosis of varices, due to underlying medical conditions. Fifteen patients survived 6 months or more after initial thrombosis without rebleeding. Child class B patients are better candidates for this treatment technique because more favorable treatment results are expected in them. Child class C patients with massive ascites and severely contracted and rigid liver pose a significant technical challenge, but in about one-third, successful control of variceal bleeding can be achieved. Most of those who survived more than 6 months showed varying degrees of improvement in clinical signs and symptoms.