Skip to main content
SpringerLink
Log in

A prognostic evaluation of endoscopic intravariceal injection sclerotherapy for esophageal varices

  • Original Article
  • Published:
Gastroenterologia Japonica Aims and scope Submit manuscript

Summary

Eighty cases of endoscopic injection sclerotherapy for esophageal varices were retrospectively studied to evaluate their prognoses. These cases were evaluated in terms of post-therapeutic bleeding, survival rates and causes of death. Post-therapeutic bleeding occurred in 50% of the emergency cases (26 cases), 25% of the elective cases (16 cases) and 23.7% of the prophylactic cases (38 cases). The frequency of post-therapeutic bleeding was significantly lower in cases with variceal obliteration than in cases without obliteration. An evaluation of the survival rates by the Kaplan-Meier method revealed that poor prognostic factors in sclerotherapy cases were emergency cases, Child’s C group, post-therapeutic cases with unsuccessfully obliterated varices, and cases with post-therapeutic bleeding. Concerning early death within 7 days after sclerotherapy, 4 emergency cases died from initial variceal bleeding despite sclerotherapy. Three of these 4 were hepatocellular carcinoma cases, and all 3 cases had tumor thrombi of the portal vein. We recommend prophylactic sclerotherapy from the standpoint of the prognosis after sclerotherapy. However, in the bleeding cases of hepatocellular carcinoma in Child’s C group complicated by tumor thrombi of the portal vein, overly enthusiastic application of the therapy should be avoided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Takase Y, Ozaki A, Orii K, et al: Injectin sclerotherapy of esophageal varices for patients undergoing emergency and elective surgery. Surgery 1982;92:474–479

    PubMed  CAS  Google Scholar 

  2. Paschke E, Paquet KT: Management of hemorrhage from esophageal varices using the esophagoscopic scleroing method. Ann Surg 1973;177:99–102

    Google Scholar 

  3. Johnston GW, Rodgers HW: A review of 15 years’ experience in the use of sclerotherapy in the control of acute haemorrhage from oesophageal varices. Br J Surg 1973;60:797–800

    Article  PubMed  CAS  Google Scholar 

  4. Terblanche J, Northover JMA, Bornman P, et al: A prospective evaluatin of injection sclerotherapy in the treatment of acute bleeding from esophageal varices. Surgery 1979;85:239–245

    PubMed  CAS  Google Scholar 

  5. Paquet KJ: Endoscopic paravariceal injection sclerotherapy of the esophagus -indications, technique, complications: results of a period of 14 years. Gastrointest Endosc 1983;29:310–315

    Article  PubMed  CAS  Google Scholar 

  6. Terblanche J, Bornman P, Kahn D, et al: Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding. A five-year prospective controlled clinical trial. Lancet 1983;2:1328–1332

    Article  PubMed  CAS  Google Scholar 

  7. Macdougall BRD, Westaby D, Theodossi A, et al: Increased long-term survival in variceal haemorrhage using injection sclerotherapy. Results of a controlled trial. Lancet 1982; 1:124–127

    Article  PubMed  CAS  Google Scholar 

  8. Japanese Research Society for Portal Hypertension: The general rules for recording endoscopic findings on esophageal varices. Jap J surg 1980;10:84–87

    Article  Google Scholar 

  9. Liver Cancer Study Group of Japan: The general rules for the clinical and pathological study of primary liver cancer. Kanehara Shuppan, Tokyo. 1987 (in Jpn)

    Google Scholar 

  10. Kaplan KL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:475–481

    Article  Google Scholar 

  11. Ishida M, Sugita T, Kubota M, et al: The clinical aspects of upper gastrointestinal bleeding in cirrhotic patients. Progress of Digestive Endoscopy 1985;27:25–30 (in Jpn)

    CAS  Google Scholar 

  12. Warren WD, Zeppa R, Fomon JJ: Selective trans-splenic decompression of gastroesophageal varices by distal splenorenal shunt. Ann Surg 1967;166:437–455

    Article  PubMed  CAS  Google Scholar 

  13. Inokuchi K: A selective portacaval shunt. Lancet 1968;2:51–52

    Article  PubMed  CAS  Google Scholar 

  14. Sugiura M, Futagawa S: A new technique for treating esophageal varices. J Thorac Cardiovasc Surg 1973;66:677–685

    PubMed  CAS  Google Scholar 

  15. Benner KG, Keeffe EB, Keller FS, et al: Clinical outcome after percutaneous transhepatic obliteration of esophageal varices. Gastroenterology 1983;85:146–153

    PubMed  CAS  Google Scholar 

  16. Lebrec D, Poynard T, Hillon P, et al: Propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis. A controlled study. N Engl J Med 1981;305:1371–1374

    Article  PubMed  CAS  Google Scholar 

  17. Layrargues GP, Villeneuve JP, Willems B, et al: Systemic and hapatic hemodynamics after variceal hemorrhage: Effects of propranolol and placebo. Gastroenterology 1987;93:1218–1224

    Google Scholar 

  18. Clark AW, Macdougall BRD, Westaby D, et al: Prospective controlled trial of injection sclerotherapy in patients with cirrhosis and recent variceal haemorrhage. Lancet 1980;2:552–554

    Article  PubMed  CAS  Google Scholar 

  19. Obara K, Masaki M, Sakamoto H, et al: Studies on prognosis of patients with esophageal and gastric varices treated with injection sclerotherapy using EO or EO-AS combined method. Gastroenterol Endosc 1987;29:2232–2236 (in Jpn)

    Google Scholar 

  20. Westaby D, Macdougall BRD, Melia W, et al: A prospective randomized study of two sclerotherapy techniques for esophageal varices. Hepatology 1983;3:681–684

    Article  PubMed  CAS  Google Scholar 

  21. Barsoum MS, Mooro HA, Bolous FI, et al: The complications of injection sclerotherapy of bleeding oesophageal varices. Br J Surg 1982;69:79–81

    Article  PubMed  CAS  Google Scholar 

  22. Inoue R, Toyonaga A, Ohkubo K, et al: Elective and prophylatic endoscopic injection sclerotherapy for esophageal varices. It’s influence on liver function with portographic and prognostic evaluation. Jpn J Gastroenterol 1986;83:669–678 (in Jpn)

    CAS  Google Scholar 

  23. Kage M, Korula J, Harada A, et al: Effects of sodium tetradecyl sulfate endoscopic variceal sclerotherapy on the esophagus. A prospective clinical and histopathologic study. J Clin Gastroenterol 1987;9:635–643

    Article  PubMed  CAS  Google Scholar 

  24. Koff RS: Benefit of endoscopy in upper gastrointestinal bleeding in patients with liver disease. Dig Dis Sci 1981;26:12s-16s

    Article  PubMed  CAS  Google Scholar 

  25. Korula J, Balart LA, Radvan G, et al: A prospective, randomized controlled trial of chronic esophageal variceal sclerotherapy. Hepatology 1985;5:584–589

    Article  PubMed  CAS  Google Scholar 

  26. Weataby D, Macdougall BRD, Williams R: Improved survival following injection sclerotherapy for esophageal varices: Final analysis of a controlled trial. Hepatology 1985;5:827–830

    Article  Google Scholar 

  27. The Copenhagen Esophageal Varices Sclerotherapy Project: Sclerotherapy after first variceal hemorrhage in cirrhosis. A randomized multicenter trial. N Engl J Med 1984;311:1594–1600

    Article  Google Scholar 

  28. DiMagno EP, Zinsmeister AR, Larson DE, et al: Influence of hepatic reserve and cause of esophageal varices on survival and rebleeding before and after the introduction of sclerotheray. A retrospective analysis. Mayo Clin Proc 1985;60:149–157

    PubMed  CAS  Google Scholar 

  29. Sauerbruch T, Weinzierl M, Köpcke W, et al: Long-term sclerotherapy of bleeding esophageal varices in patients with liver cirrhosis. An evaluation of mortality and rebleeding risk factors. Scand J Gastroenterol 1985;20:51–58

    Article  PubMed  CAS  Google Scholar 

  30. Prindiville T, Miller M, Trudeau W: Prognostic indicators in acute variceal hemorrhage after treatment by sclerotherapy. Am J Gstroenterol 1987;82:655–659

    CAS  Google Scholar 

  31. Santangelo WC, Dueno MI, Estes BL, et at: Prophylactic sclerotherapy of large esophageal varices. N Enle J Med 1988;318:814–818

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Second Department of Internal Medicine, Dokkyo University School of Medicine, 880, Kitakobayashi, Mibu-machi, 321-02, Shimotsuga-gun, Tochigi, Japan

    Motoo Ishida M.D. & Hironori Masuyama

Authors
  1. Motoo Ishida M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hironori Masuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ishida, M., Masuyama, H. A prognostic evaluation of endoscopic intravariceal injection sclerotherapy for esophageal varices. Gastroenterol Jpn 24, 347–356 (1989). https://doi.org/10.1007/BF02774339

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02774339

Key words

Search

Navigation