Bleeding oesophageal varices in alcoholic cirrhosis: long-term follow-up of endoscopic sclerotherapy.Q J Med. 1993 Apr; 86(4):241-5.QJ
Between 1977 and 1984, 53 consecutive unselected patients with bleeding oesophageal varices and alcoholic cirrhosis were treated by endoscopic sclerotherapy. Ten died during their index bleed, and 10 died within the following year due to hepatic failure (five), non-liver related causes (three), bleeding varices (one) and hepatocellular carcinoma (one). After the first year, a further three patients died of bleeding varices, eight died of hepatic failure (including one hepatocellular carcinoma) and six died of unrelated problems. Patients with hepatic disease of Childs-Pugh grade C died earlier than those of grade A and B grade (p < 0.01). There were 24 variceal recurrences within 1 year of completing sclerotherapy and seven recurrences later. Abstemious alcoholics rarely rebled and none developed recurrent varices after 18 months without recurrence. The size of the original varices, the number of sessions required to obliterate them, and the total volume of sclerosant used did not correlate with duration of remission. Continuing drinkers were more likely to present with bleeding varices (six of nine) than asymptomatic recurrences (one of 23) (p < 0.0001). In this study endoscopic sclerotherapy prevented deaths from variceal bleeds but there was a continued risk of death from hepatic failure and other unrelated causes.