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Sclerotherapy of bleeding oesophageal varices by means of endoscopy
Insights
Sclerotherapy effectively stopped bleeding in 90% of patients with esophageal varices. This treatment is a top choice for massive hemorrhage, especially in patients with poor liver function.
Area of Science:
- Gastroenterology and Hepatology
- Interventional Endoscopy
Background:
- Gastroesophageal varices are a common complication of portal hypertension, often leading to life-threatening hemorrhage.
- Traditional treatments for variceal bleeding have limitations, necessitating alternative therapeutic approaches.
Purpose of the Study:
- To evaluate the efficacy and safety of esophageal wall sclerotherapy for managing hemorrhage from gastroesophageal varices.
- To determine the long-term outcomes and identify patient subgroups who benefit most from this intervention.
Main Methods:
- A retrospective analysis of 640 patients treated with esophageal wall sclerotherapy between 1969 and 1977.
- Sclerotherapy sessions were administered to stop active bleeding or prevent recurrence, with follow-up assessments of hemostasis and survival.
Main Results:
- Sclerotherapy successfully controlled hemorrhage in 90% of patients within four months.
- Overall mortality was 14.5%, with liver coma and uncontrollable hemorrhage being primary causes.
- 65% of patients survived, with 50% living longer than one year, up to eight years post-treatment.
Conclusions:
- Esophageal wall sclerotherapy is a highly effective treatment for massive, intractable gastroesophageal variceal hemorrhage.
- It is particularly indicated for patients with decompensated liver function or when shunt procedures are not feasible.
- The procedure offers a favorable long-term survival rate, establishing it as a method of choice.
Abstract:
From 1.1.1969 up to 1.11.1977, 640 patients with hemorrhage from gastro-oesopheal varices were managed by sclerotherapy of the oesophageal wall. In 90% this method succeeded in stopping hemorrhage or preventing a new bleeding during the next four months. Only 43 patients of the total number were treated because of impending hemorrhage under precise indications. After two or three sessions of sclerotherapy the interval of control can be extended up to one years without new danger of hemorrhage. Overall mortality was 14.5%; main causes of death were liver coma, uncontrollable hemorrhage, mediastinitis and pyothorax.--If liver function improves, a porto-systemic-shunt is performed whenever possible.--416 = 65% of the patients are still alive; 50% longer than one year up to eight years. Thus sclerotherapy seems to be the method of choice in uncurable massive hemorrhage from varicosities from the oesophagus. It is indicated in patients with decompensated liver function, and whenever a shunt procedure is anatomically or clinically impossible or not advisable, too.