Prophylactic sclerotherapy of high‐risk esophageal varices: Results of a multicentric prospective controlled trial

In this prospective, multicenter trial, 140 cirrhotic patients with no previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage were randomized to receive either sclerotherapy or conservative treatment for the prevention of first var...

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Veröffentlicht in:Hepatology (Baltimore, Md.) Md.), 1988-11, Vol.8 (6), p.1495-1500
Hauptverfasser: Piai, Guido, Cipolletta, Livio, Claar, Max, Marone, Giampiero, Bianco, Maria Antonietta, Forte, Giovanni, Iodice, Giuseppe, Mattera, Daniele, Minieri, Mauro, Rocco, Pietro, Santoro, Lorenzo Michele, Mazzacca, Gabriele
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container_end_page 1500
container_issue 6
container_start_page 1495
container_title Hepatology (Baltimore, Md.)
container_volume 8
creator Piai, Guido
Cipolletta, Livio
Claar, Max
Marone, Giampiero
Bianco, Maria Antonietta
Forte, Giovanni
Iodice, Giuseppe
Mattera, Daniele
Minieri, Mauro
Rocco, Pietro
Santoro, Lorenzo Michele
Mazzacca, Gabriele
description In this prospective, multicenter trial, 140 cirrhotic patients with no previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage were randomized to receive either sclerotherapy or conservative treatment for the prevention of first variceal bleeding. The end‐points of the study were bleeding and death. Life table curves showed that prophylactic sclerotherapy significantly diminished the incidence of variceal hemorrhage (p < 0.001) and overall mortality (p < 0.01). Two‐year cumulative bleeding rate was 18% in the sclerosis group (95% confidence interval = 10 and 31) and 57% (95% confidence interval = 40 and 72) in the control group. Two‐year cumulative mortality rate was 30% (95% confidence interval = 19 and 45) in the sclerotherapy group and 56% (95% confidence interval = 39 and 72) in the controls. One patient died after hemorrhage from an ulcer secondary to sclerotherapy. Analysis by the Cox model of the factors potentially confounding or interacting with the effect of sclerotherapy suggested that sclerotherapy was more efficient in preventing first bleeding in patients with decompensated disease (Child B and C) than in those in good condition (Child A). However, the 2‐year cumulative bleeding rate of untreated Child A patients was only 19%, showing how in this group the endoscopic findings were unreliable in selecting high‐risk varices and explaining why after a 2‐year follow‐up prophylactic sclerosis did not show any benefit in such patients. We conclude that sclerotherapy can decrease the incidence of first variceal bleeding and death for a period of 2 years in cirrhotic patients with high‐risk varices.
doi_str_mv 10.1002/hep.1840080605
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However, the 2‐year cumulative bleeding rate of untreated Child A patients was only 19%, showing how in this group the endoscopic findings were unreliable in selecting high‐risk varices and explaining why after a 2‐year follow‐up prophylactic sclerosis did not show any benefit in such patients. We conclude that sclerotherapy can decrease the incidence of first variceal bleeding and death for a period of 2 years in cirrhotic patients with high‐risk varices.</description><identifier>ISSN: 0270-9139</identifier><identifier>EISSN: 1527-3350</identifier><identifier>DOI: 10.1002/hep.1840080605</identifier><identifier>PMID: 3056821</identifier><identifier>CODEN: HPTLD9</identifier><language>eng</language><publisher>Philadelphia, PA: W.B. 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Liver. Pancreas. Abdomen</topic><topic>Gastrointestinal Hemorrhage - etiology</topic><topic>Gastrointestinal Hemorrhage - mortality</topic><topic>Gastrointestinal Hemorrhage - prevention &amp; control</topic><topic>Humans</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - drug therapy</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Other diseases. 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However, the 2‐year cumulative bleeding rate of untreated Child A patients was only 19%, showing how in this group the endoscopic findings were unreliable in selecting high‐risk varices and explaining why after a 2‐year follow‐up prophylactic sclerosis did not show any benefit in such patients. We conclude that sclerotherapy can decrease the incidence of first variceal bleeding and death for a period of 2 years in cirrhotic patients with high‐risk varices.</abstract><cop>Philadelphia, PA</cop><pub>W.B. Saunders</pub><pmid>3056821</pmid><doi>10.1002/hep.1840080605</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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subjects Adult
Aged
Biological and medical sciences
Clinical Trials as Topic
Esophageal and Gastric Varices - complications
Esophageal and Gastric Varices - mortality
Esophageal and Gastric Varices - therapy
Female
Gastroenterology. Liver. Pancreas. Abdomen
Gastrointestinal Hemorrhage - etiology
Gastrointestinal Hemorrhage - mortality
Gastrointestinal Hemorrhage - prevention & control
Humans
Liver Cirrhosis - complications
Liver Cirrhosis - drug therapy
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Prospective Studies
Random Allocation
Sclerosing Solutions - therapeutic use
title Prophylactic sclerotherapy of high‐risk esophageal varices: Results of a multicentric prospective controlled trial
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