식도정맥류 출혈시 내시경적 경화요법과 Propranolol 의 병용투여가 재출혈과 생존율에 미치는 효과

Objectives: We conducted this study to evaluate the therapeutic efficacy of endoscopic sclerotherapy combined with oral propranolol therapy in the prevention of esophageal variceal rebleeding and in survival rate in patients with liver cirrhosis. Methods: Among the 54 patients involved, 34 patients were treated with the combination therapy using endoscopic sclerotherapy and propranolol and 20 were received sclerotherapy alone. Sclerotherapy was done with ethalnolamine oleate at 7-day intervals untill obliteration of varices was achieved. Propranolol was administered to achieve a reduction in resting pulse rate of 20~25%. Results ; Of the patients treated with the combination therapy, 69.6%, 56.4% and 25.1% were free from rebleeding at 6, 12 and 24 months after entry, respectively. The corresponding figures in patients treated with sclerotherapy alone were 50.5%, 27.5% and 7.5% respectively. The cumulative percentages of the patients free from rebleeding were significantly higher in the combination therapy group than in the latter group (p=0.022). The cumulative survival rates, at 6, 12 and 24 months, of the patients received the combination therapy were 81.9%, 72.5% and 55.8% respectively. The corresponding survival rates in the patients treated with sclerotherapy alone were 77.5%, 53.2% and 11.2% respectively. The cumulative survival rate in patients recerved the combination therapy was significantly higher than those of the latter group (p= 0.004). The multivariate Cox model individuated the propranolol treatment as an independent prognostic indicator of the death rate, but not for the recurrent bleeding. During this study, no significant adverse effect was observed in both group. Conclusion: The combination therapy using endoscopic sclerotherapy and propranolol has shown to be an effective treatment in the prevention of recurrent variceal bleeding as well as in the prolongation of survival rate in cirrhotic patients. Therefore, this method of treatment may be considered as standard therapy of esophageal variceal bleeding.