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Variceal haemorrhage. A study of unselected patients with massive bleeding from oesophageal varices
Insights
Massive bleeding from esophageal varices, common in alcoholic cirrhosis patients, has high mortality despite modern treatments. Patient survival strongly correlates with liver disease severity, suggesting conservative management may be optimal.
Area of Science:
- Gastroenterology
- Hepatology
- Critical Care Medicine
Background:
- Massive hemorrhage from esophageal varices is a life-threatening complication, particularly in patients with alcoholic cirrhosis.
- High-risk liver disease patients often present with variceal bleeding, necessitating effective management strategies.
Purpose of the Study:
- To evaluate the outcomes of patients treated for massive esophageal variceal hemorrhage.
- To assess the impact of various treatment modalities on mortality and survival rates.
- To determine the relationship between liver disease severity and patient prognosis.
Main Methods:
- Retrospective analysis of 105 unselected patients with esophageal variceal hemorrhage.
- Diagnosis confirmed by early endoscopy and/or autopsy.
- Treatment included conservative measures (balloon-tamponade, vasopressin infusion) and additional therapies (shunt surgery, variceal obliteration, endoscopic sclerotherapy).
Main Results:
- High hospital mortality rates: 50% during the first bleeding episode and 35% during recurrent episodes.
- Overall hospital mortality was 44%, with a mean one-year survival of 30%.
- Patient survival was strongly correlated with the severity of underlying liver disease at admission.
Conclusions:
- Despite intensive care and modern interventions, massive esophageal variceal bleeding carries a high mortality.
- The severity of liver disease is a critical determinant of both short-term and long-term survival.
- Conservative, non-operative management may offer comparable or better outcomes than complex surgical interventions in high-risk patients.
Abstract:
A series of 105 unselected patients treated at Södersjukhuset, Stockholm, Sweden 1976-1979 for massive haemorrhage from oesophageal varices is presented. Ninety per cent of the patients had alcoholic cirrhosis and 60% belonged to the poorest liver risk group on admission. The diagnosis of variceal haemorrhage was assessed by early endoscopy and/or autopsy. Treatment was mainly conservative, balloon-tamponade or vasopressin infusion. Twenty-five patients received additional therapy; Portacaval shunt surgery, percutaneous transhepatic variceal obliteration or endoscopic injection sclerotherapy. Despite this treatment along with early panendoscopy and modern intensive care facilities the mortality remained high. The hospital mortality was 50% during the first bleeding episode and 35% during recurrent variceal haemorrhage. Average hospital mortality was 44% and mean one year survival was 30%. In this study the long and short time survival after variceal bleeding relates strongly to the severity of the liver disease on admission. This must be fully taken into consideration before adopting sophisticated and costly operative techniques when simple nonoperative measures would give the same or better results.