[Endoscopic sclerotherapy of hemorrhagic esophageal varices. 86 cases]

Haemorrhage due to rupture of oesophageal varices is a major cause of death in patients with cirrhosis. We evaluated retrospectively our results with endoscopic sclerosis in order to evaluate recurrence, compliance and long-term survival.

Endoscopic sclerosis was performed with a flexible endoscope in 86 patients from 1986 to 1989. Ninety-nine percent of the patients had cirrhosis; they were equally distributed in the 3 Child-Pugh classes. Sclerosis was performed once a week for three weeks then once every 3 weeks until eradication. Sessions was performed during an episode of haemorrhage in 17 patients and begun after bleeding had stopped in 69 others. Mean clinical follow-up was 24 +/- 14 months and mean endoscopic follow-up, 19 +/- 15 months.

The mean number of sessions was 5.3 +/- 3.5 (range 1-17) per patient. Haemostasis was obtained in 4 out of 17 patients treated in emergency situations. Eradication was attained in 50 patients (58%). Recurrent varices were observed in 28 of these 50 and recurrent bleeding in 13, leading to 2 deaths. Global mortality over the period studied was 36%: 24 patients died before eradication, 7 after and 2 due to extra-hepatic causes. More than two-thirds of the deaths occurred during the first 2 months, mainly after recurrent bleeding. Global actuarial survival was 70% at 12 months, 62% at 24 months and 56% at 36 months. There was a significant difference in actuarial survival between Child-Pugh classes A and B patients and Child-Pugh class C patients.

Our experience and the data in the literature indicate that sclerosis can be beneficial in patients with haemorrhagic oesophageal varices, but must be carried out within the framework of comprehensive care and follow-up.