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Prophylactic sclerotherapy before the first episode of variceal hemorrhage in patients with cirrhosis.
N Engl J Med. 1988 Jul 07; 319(1):8-15.NEJM

Abstract

The value of sclerotherapy as prophylaxis against the first episode of variceal hemorrhage has not been established. Therefore, we randomly assigned 133 patients with cirrhosis of the liver (of alcoholic origin in 66 percent), esophageal varices, and no previous intestinal bleeding to either prophylactic sclerotherapy (n = 68) or no prophylaxis (n = 65). The groups were comparable in hepatic function, endoscopic findings, and the pathogenesis of cirrhosis. All patients who subsequently had a first episode of variceal hemorrhage received sclerotherapy whenever possible. During a median follow-up of 22 months, variceal hemorrhage occurred in 28 percent of the patients receiving sclerotherapy and 37 percent of the controls (P = 0.3). Thirty-five percent of the sclerotherapy group and 46 percent of the control group died. The survival curves (Kaplan-Meier) of both groups were similar (P = 0.2). However, among patients with alcoholic and moderately decompensated cirrhosis (Child-Pugh group B), survival was significantly higher in those receiving sclerotherapy, although the risk of bleeding was only marginally reduced by this procedure. We conclude that prophylactic sclerotherapy does not significantly reduce the risk of bleeding from esophageal varices, but that a subgroup of patients with esophageal varices and moderately decompensated alcoholic cirrhosis may benefit from prophylactic sclerotherapy because of factors not solely attributable to prevention of an initial episode of variceal bleeding.

Authors+Show Affiliations

Department of Internal Medicine II, Klinikum Grosshadern, University of Munich, West Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

3288871

Citation

Sauerbruch, T, et al. "Prophylactic Sclerotherapy Before the First Episode of Variceal Hemorrhage in Patients With Cirrhosis." The New England Journal of Medicine, vol. 319, no. 1, 1988, pp. 8-15.
Sauerbruch T, Wotzka R, Köpcke W, et al. Prophylactic sclerotherapy before the first episode of variceal hemorrhage in patients with cirrhosis. N Engl J Med. 1988;319(1):8-15.
Sauerbruch, T., Wotzka, R., Köpcke, W., Härlin, M., Heldwein, W., Bayerdörffer, E., Sander, R., Ansari, H., Starz, I., & Paumgartner, G. (1988). Prophylactic sclerotherapy before the first episode of variceal hemorrhage in patients with cirrhosis. The New England Journal of Medicine, 319(1), 8-15.
Sauerbruch T, et al. Prophylactic Sclerotherapy Before the First Episode of Variceal Hemorrhage in Patients With Cirrhosis. N Engl J Med. 1988 Jul 7;319(1):8-15. PubMed PMID: 3288871.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prophylactic sclerotherapy before the first episode of variceal hemorrhage in patients with cirrhosis. AU - Sauerbruch,T, AU - Wotzka,R, AU - Köpcke,W, AU - Härlin,M, AU - Heldwein,W, AU - Bayerdörffer,E, AU - Sander,R, AU - Ansari,H, AU - Starz,I, AU - Paumgartner,G, PY - 1988/7/7/pubmed PY - 1988/7/7/medline PY - 1988/7/7/entrez SP - 8 EP - 15 JF - The New England journal of medicine JO - N Engl J Med VL - 319 IS - 1 N2 - The value of sclerotherapy as prophylaxis against the first episode of variceal hemorrhage has not been established. Therefore, we randomly assigned 133 patients with cirrhosis of the liver (of alcoholic origin in 66 percent), esophageal varices, and no previous intestinal bleeding to either prophylactic sclerotherapy (n = 68) or no prophylaxis (n = 65). The groups were comparable in hepatic function, endoscopic findings, and the pathogenesis of cirrhosis. All patients who subsequently had a first episode of variceal hemorrhage received sclerotherapy whenever possible. During a median follow-up of 22 months, variceal hemorrhage occurred in 28 percent of the patients receiving sclerotherapy and 37 percent of the controls (P = 0.3). Thirty-five percent of the sclerotherapy group and 46 percent of the control group died. The survival curves (Kaplan-Meier) of both groups were similar (P = 0.2). However, among patients with alcoholic and moderately decompensated cirrhosis (Child-Pugh group B), survival was significantly higher in those receiving sclerotherapy, although the risk of bleeding was only marginally reduced by this procedure. We conclude that prophylactic sclerotherapy does not significantly reduce the risk of bleeding from esophageal varices, but that a subgroup of patients with esophageal varices and moderately decompensated alcoholic cirrhosis may benefit from prophylactic sclerotherapy because of factors not solely attributable to prevention of an initial episode of variceal bleeding. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/3288871/Prophylactic_sclerotherapy_before_the_first_episode_of_variceal_hemorrhage_in_patients_with_cirrhosis_ L2 - https://www.nejm.org/doi/10.1056/NEJM198807073190102?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -