Related Experiment Videos
A trial of elective versus on demand sclerotherapy in "poor risk" patients with variceal haemorrhage
R F McKee1, O J Garden, J R Anderson
1University Department of Surgery, Royal Infirmary, Glasgow, Scotland.
Insights
Planned chronic injection sclerotherapy did not improve survival for high-risk patients with esophageal variceal bleeding compared to demand sclerotherapy. This study found no significant survival difference between the two sclerotherapy approaches.
Area of Science:
- Gastroenterology
- Hepatology
- Interventional Endoscopy
Background:
- Esophageal variceal bleeding poses a significant risk in patients with liver disease.
- Identifying optimal management strategies for high-risk patients is crucial.
Purpose of the Study:
- To compare the efficacy of planned chronic injection sclerotherapy versus demand injection sclerotherapy in patients with endoscopically proven variceal bleeding.
- To assess the impact on survival and rebleeding rates in poor-risk patients.
Main Methods:
- A prospective randomized trial involving 40 patients with endoscopically proven variceal bleeding.
- Patients were either modified Child's grade C or over 65 years of age.
- Comparison between scheduled (three-weekly) and on-demand (post-bleed) sclerotherapy.
Main Results:
- One-year survival was 45% and two-year survival was 37% overall.
- No significant difference in survival was observed between the planned and demand sclerotherapy groups at one or two years.
- Gastrointestinal bleeds occurred in 11 patients (24 bleeds) in the planned group and 13 patients (35 bleeds) in the demand group.
Conclusions:
- Planned chronic injection sclerotherapy did not demonstrate improved survival in this cohort of poor-risk patients.
- Further research may be needed to refine sclerotherapy protocols for specific patient subgroups.
Abstract:
A prospective randomised trial of "planned" chronic injection sclerotherapy (at three weekly intervals) versus "demand" injection sclerotherapy (after variceal bleeds only) was performed in 40 patients who had endoscopically proven variceal bleeding, and who were either graded as modified Child's grade C or were more than 65 years of age. 45% of patients survived for one year and 37% for two years. There was no significant difference in survival between the groups at either one or two years (p < 0.5; p < 0.1). In the "planned" sclerotherapy group 24 gastrointestinal bleeds occurred in 11 patients over the first nine months after study entry. In the "demand" group 35 bleeds occurred in 13 patients over the first 18 months after study entry. In this small group of "poor risk" patients, planned chronic injection sclerotherapy was not associated with improved survival.