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Natural history of bleeding after esophageal variceal eradication in patients with extrahepatic portal venous obstruction; a 20-year follow-up

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Abstract

Background

Long-term follow-up studies of patients with extrahepatic portal venous obstruction (EHPVO) after eradication of esophageal varices using endoscopic sclerotherapy (EST) are limited.

Methods

Between 1985 and 1994, 223 patients with bleeding esophageal varices due to EHPVO underwent variceal eradication using EST. Regular annual clinical and endoscopic follow-up data were available for 198 of these patients for a mean period of 19.8 (range: 14–23) years. These data were analyzed retrospectively.

Results

Of the 198 patients, 34 (17.2%) had rebleeding after variceal eradication. The mean duration from variceal eradication to recurrence of bleeding was 5.4 years. The causes of rebleeding were: recurrent esophageal varices in 21 patients, fundal varices in eight, portal gastropathy in three, and ectopic varices in two patients. Esophageal varices reappeared in 39 (19.7%) patients. Fundal varices appeared in 19 (9.5%) patients during follow-up.

Conclusions

EST is an effective treatment modality for bleeding esophageal varices due to EHPVO. During a follow-up of nearly 20 years after variceal eradication, only about one-sixth of the patients had recurrence of gastrointestinal bleeding. Bleeding was unusual after 10 years had passed since initial variceal eradication.

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References

  1. Anand CS, Tandon BN, Nundy S. The causes, management and outcome of upper gastrointestinal hemorrhage in an Indian hospital. Br J Surg 1983;70:209–11.

    Article  CAS  PubMed  Google Scholar 

  2. Sarin SK, Agarwal SR. Extrahepatic portal vein obstruction. Semin Liver Dis 2002;22:43–58.

    Article  PubMed  Google Scholar 

  3. Szczepanik AB, Rudowski WJ. Extra-hepatic portal hypertension: long-term results of surgical treatment. Ann R Coll Surg Engl 1989;71:222–5.

    CAS  PubMed  Google Scholar 

  4. Zargar SA, Yattoo GN, Javid G, et al. Fifteen-year follow up of endoscopic injection sclerotherapy in children with extrahepatic portal venous obstruction. J Gastroenterol Hepatol 2004;19:139–45.

    Article  PubMed  Google Scholar 

  5. Paquet KJ. Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices — a prospective controlled randomized trial. Endoscopy 1982;14:4–5.

    Article  CAS  PubMed  Google Scholar 

  6. Ramchandran TM, John A, Ashraf SS, Moosabba MS, Nambiar PV, Shobana Devi R. Hemoperitoneum following rupture of ectopic varix along splenorenal ligament in extrahepatic portal vein obstruction. Indian J Gastroenterol 2000;19:91.

    CAS  PubMed  Google Scholar 

  7. Alvarez F, Bernard O, Brunelle F, Hadchouel P, Odievre M, Alagille D. Portal obstruction in children. Clinical investigation and hemorrhage risk. J Pediatr 1983;103:696–702.

    Article  CAS  PubMed  Google Scholar 

  8. Mitra SK, Kumar V, Datta DV, et al. Extrahepatic portal hypertension: a review of 70 cases. J Pediatr Surg 1978;13:51–7.

    Article  CAS  PubMed  Google Scholar 

  9. Dilawari JB, Chawla YK, Ramesh GN, Mitra SK, Walia BN. Endoscopic sclerotherapy in children. J Gastroenterol Hepatol 1989;4:155–60.

    Article  CAS  PubMed  Google Scholar 

  10. Howard ER, Stringer MD, Mowat AP. Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices. Br J Surg 1988;75:404–8.

    Article  CAS  PubMed  Google Scholar 

  11. de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2005;43:167–76.

    Article  PubMed  Google Scholar 

  12. Yachha SK, Sharma BC, Kumar M, Khanduri A. Endoscopic sclerotherapy for esophageal varices in children with extrahepatic portal venous obstruction: a follow-up study. J Pediatr Gastroenterol Nutr 1997;24:49–52.

    Article  CAS  PubMed  Google Scholar 

  13. Hill ID, Bowie MD. Endoscopic sclerotherapy for control of bleeding varices in children. Am J Gastroenterol 1991;86:472–6.

    CAS  PubMed  Google Scholar 

  14. Itha S, Yachha SK. Endoscopic outcome beyond esophageal variceal eradication in children with extrahepatic portal venous obstruction. J Pediatr Gastroenterol Nutr 2006;42:196–200.

    Article  PubMed  Google Scholar 

  15. Krige JE, Bornman PC, Goldberg PA, Terblanche J. Variceal rebleeding and recurrence after endoscopic injection sclerotherapy: a prospective evaluation in 204 patients. Arch Surg 2000;135:1315–22.

    Article  CAS  PubMed  Google Scholar 

  16. Sarin SK, Govil A, Jain AK, et al. Prospective randomized trial of sendoscopic sclerotherapy versus variceal band ligation for esophageal varices: influence on gastropathy, gastric varices and variceal recurrence. J Hepatol 1997;26:826–32.

    Article  CAS  PubMed  Google Scholar 

  17. Hou MC, Lin HC, Lee FY, Chang FY, Lee SD. Recurrence of esophageal varices following endoscopic treatment and its impact on rebleeding: comparison of sclerotherapy and ligation. J Hepatol 2000;32:202–8.

    Article  CAS  PubMed  Google Scholar 

  18. Sakai T, Iwao T, Oho K, Toyonaga A, Tanikawa K. Influence of extravariceal collateral channel pattern on recurrence of esophageal varices after sclerotherapy. J Gastroenterol 1997;32:715–9.

    Article  CAS  PubMed  Google Scholar 

  19. Stringer MD, Howard ER. Long term outcome after injection sclerotherapy for oesophageal varices in children with extrahepatic portal hypertension. Gut 1994;35:257–9.

    Article  CAS  PubMed  Google Scholar 

  20. Yuksel O, Koklu S, Arhan M, et al. Effects of esophageal variceal eradication on portal hypertensive gastropathy and fundal varices: a retrospective and comparative study. Dig Dis Sci 2006;51:27–30.

    Article  PubMed  Google Scholar 

  21. Thomas V, Tony J, Harish K, Harikumar R, Sunilkumar K. Endoscopic abnormalities in the oesophagus after variceal sclerotherapy: a long-term follow up study. Trop Gastroenterol 2007;28:24–7.

    PubMed  Google Scholar 

  22. Macias Rodriguez MA, Soria de la Cruz MJ, Iglesias Arrabal M, Martin Herrera L. Esophageal carcinoma after the endoscopic sclerotherapy of varices. Re Esp Enferm Dig 1992;82:43–6.

    CAS  Google Scholar 

  23. Zargar SA, Javid G, Khan BA, et al. Endoscopic ligation vs. sclerotherapy in adults with extrahepatic portal venous obstruction: a prospective randomized study. Gastrointest Endosc 2005;61:58–66.

    Article  PubMed  Google Scholar 

  24. de la Pena J, Rivero M, Sanchez E, Fabrega E, Crespo J, Pons-Romero F. Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage: prospective randomized trial. Gastrointest Endosc 1999;49:417–23.

    Article  PubMed  Google Scholar 

  25. Zargar SA, Javid G, Khan BA, et al. Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction. Hepatology 2002;36:666–72.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Calicut Medical College, Calicut, 673 008, Kerala, India

    Varghese Thomas, Tony Jose & Sunil Kumar

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  1. Varghese Thomas
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  2. Tony Jose
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  3. Sunil Kumar
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Correspondence to Varghese Thomas.

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Thomas, V., Jose, T. & Kumar, S. Natural history of bleeding after esophageal variceal eradication in patients with extrahepatic portal venous obstruction; a 20-year follow-up. Indian J Gastroenterol 28, 206–211 (2009). https://doi.org/10.1007/s12664-009-0086-0

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  • DOI: https://doi.org/10.1007/s12664-009-0086-0

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