Is there an indication for prophylactic endoscopic paravariceal injection sclerotherapy in patients with liver cirrhosis and portal hypertension?Endoscopy. 1986 May; 18 Suppl 2:32-5.E
From January 1, 1978, to January 1, 1980, a prospective controlled randomized trial comparing conservative treatment to prophylactic endoscopic paravariceal injection sclerotherapy of esophageal varices prior to hemorrhage was carried out. In all 71 patients liver cirrhosis was confirmed histologically. The two randomly assigned groups were comparable with respect to age, sex and degree of liver diseases and its histological type was also similar. Indications for endoscopic treatment were the existence of degree III to IV varices bearing telangiectasias on their top, and degree II to IV varices without telangiectasias but coagulation factors below 30%, or both. Six patients had to be excluded. In group IA--treatment by conservative means, clinical and endoscopic monitoring--a high rate of variceal bleeding (66%) and death (42%) was observed. Comparing these results with those of group IB treated by sclerotherapy, bleeding and death rates (6 and 6%) were found to be highly significantly lower. From January 1, 1980, to January 1, 1984 another 70 non-randomized patients were treated by prophylactic endoscopic paravariceal injection sclerotherapy. In this group II the frequency of hemorrhage was 4.5% and in-hospital mortality 13%. The main causes of death were hepatic coma, followed by hemorrhage from esophageal varices. After four years another 14 patients had died despite regular monitoring and re-injection (20%); the main causes of death were hepatic coma and hepatocellular cancer. Five patients (7%) were lost to follow up, while 42 (60%) are still living.(ABSTRACT TRUNCATED AT 250 WORDS)
