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Langzeitergebnisse der Skelerosierungs-therapie bei Patienten mit portaler Hypertension

Results of longterm injection sclerotherapy in patients with portal hypertension

  • Themenschwerpunkt: Neue Trends in der Therapie der Portalen Hypertonie
  • Therapie
  • Published:
Acta chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Mit Einführung der flexiblen Endoskopie kam es zu einer zunehmenden Ausbreitung der Sklerosierungsbehandlung von Ösophagusvarizen. Die notfallmäßige unterspritzung der Ösophagusvarizen ist nach den vorliegenden kontrollierten Studien die beste Methode, um eine akute Blutstillung zu erreichen. Dagegen ist die Langzeitsklerosierungstherapie mit einer Rezidivblutungsfrequenz von 30 bis 40% belastet. Sie verhindert die wiederholte Blutung weniger effizient als eine portokavale Shunt-Operation. Gleichwohl werden die Probleme der Shunt-Operation (akute Operationsletalität, hepatische Enzephalopathie oder protrahiertes postoperatives Leberversagen) vermieden, so daß primär zunächst immer eine Langzeitsklerosierungstherapie angestrebt werden kann. Die chronische Behandlung mit nichtselektiven Beta-Blockern ist einer wiederholten Verödungstherapie bezüglich Rezidivblutungsfrequenz und Überleben vergleichbar. Daher kann nach akutem Blutungsstopp durch Injektion der Varizen durchaus individuell und abhängig vom Krankheitsverlauf vorgegangen werden. Zur Prophylaxe der ersten Ösophagusvarizenblutung sollte die Skelerosierungstherapie nur innerhalb kontrollierter Studien eingesetzt werden.

Summary

The introduction of flexible endoscopy has led to numerous controlled and uncontrolled trials with respect to sclerotherapy of esophageal varices. According to randomized controlled trials injection sclerotherapy is the most successful method to achieve hemostasis of acute variceal bleeding. By contrast, long-term injection sclerotherapy with the aim of eradication of varices has the problem of recurrent bleeding in around 40% of patients. Therefore, recurrent bleeding is prevented less efficiently than by a portal systemic shunt operation. However, shunt surgery may be complicated by surgical fatalities, hepatic encephalopathy or late liver failure. These problems can be prevented if long-term sclerotherapy is the first therapeutic step which surgery as salvage in case of recurrent bleeding. According to controlled trials, the chronic intake of the a nonselective betablocker (propranolol) is equally effective to sclerotherapy in the prevention of rebleeding. Therefore, different treatment options should be considered according to the needs of the individual patient after hemostasis of acute esophageal variceal bleeding has been achieved. Prophylaxis of first variceal hemorrhage can only be recommended for patients who take part in controlled trials.

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  1. Allgemeine Innere Medizin, Medizinische Universitätsklinik, Sigmund-Freud-Straße 25, D-53127, Bonn-Venusberg, Deutschland

    T. Sauerbruch

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Sauerbruch, T. Langzeitergebnisse der Skelerosierungs-therapie bei Patienten mit portaler Hypertension. Acta Chir Austriaca 25, 159–162 (1993). https://doi.org/10.1007/BF02602086

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