Shunt surgery versus endoscopic sclerotherapy for long-term treatment of variceal bleeding: early results of a randomized trial
In September 1982, a prospective randomized trial comparing shunt surgery and endoscopic sclerotherapy for the elective management of variceal hemorrhage in patients with cirrhosis was initiated. Twenty-seven patients have received shunts (distal splenorenal = 23, nonselective = 4) and 30 patients h...
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| Veröffentlicht in: | Annals of surgery 1987-09, Vol.206 (3), p.261-271 |
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| creator | RIKKERS, L. F BURNETT, D. A VOLENTINE, G. D BUCHI, K. N CORMIER, R. A |
| description | In September 1982, a prospective randomized trial comparing shunt surgery and endoscopic sclerotherapy for the elective management of variceal hemorrhage in patients with cirrhosis was initiated. Twenty-seven patients have received shunts (distal splenorenal = 23, nonselective = 4) and 30 patients have had chronic sclerotherapy. Eighty-six per cent of patients had alcoholic cirrhosis and 33% were Child's class C. After a mean follow-up of 25 months, 19% of shunt and 57% of sclerotherapy patients have had rebleeding (p = 0.003). Kaplan-Meier survival analysis reveals similar 2-year survival rates for shunt (65%) and sclerotherapy (61%) groups. Only two of 10 sclerotherapy failures have been salvaged by surgery. Posttherapy quantitative hepatic function, frequency of encephalopathy, and cumulative medical costs were similar for both groups. Hepatic portal perfusion and portal pressure at 1 year were better maintained by sclerotherapy than by distal splenorenal shunt. In conclusion, endoscopic sclerotherapy and shunt surgery provide similar results with respect to survival, hepatic function, frequency of encephalopathy, and costs. Sclerotherapy is an acceptable, but not superior, alternative to shunt surgery for treatment of variceal hemorrhage. |
| doi_str_mv | 10.1097/00000658-198709000-00004 |
| format | Article |
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F ; BURNETT, D. A ; VOLENTINE, G. D ; BUCHI, K. N ; CORMIER, R. A</creator><creatorcontrib>RIKKERS, L. F ; BURNETT, D. A ; VOLENTINE, G. D ; BUCHI, K. N ; CORMIER, R. A</creatorcontrib><description>In September 1982, a prospective randomized trial comparing shunt surgery and endoscopic sclerotherapy for the elective management of variceal hemorrhage in patients with cirrhosis was initiated. Twenty-seven patients have received shunts (distal splenorenal = 23, nonselective = 4) and 30 patients have had chronic sclerotherapy. Eighty-six per cent of patients had alcoholic cirrhosis and 33% were Child's class C. After a mean follow-up of 25 months, 19% of shunt and 57% of sclerotherapy patients have had rebleeding (p = 0.003). Kaplan-Meier survival analysis reveals similar 2-year survival rates for shunt (65%) and sclerotherapy (61%) groups. Only two of 10 sclerotherapy failures have been salvaged by surgery. Posttherapy quantitative hepatic function, frequency of encephalopathy, and cumulative medical costs were similar for both groups. Hepatic portal perfusion and portal pressure at 1 year were better maintained by sclerotherapy than by distal splenorenal shunt. In conclusion, endoscopic sclerotherapy and shunt surgery provide similar results with respect to survival, hepatic function, frequency of encephalopathy, and costs. Sclerotherapy is an acceptable, but not superior, alternative to shunt surgery for treatment of variceal hemorrhage.</description><identifier>ISSN: 0003-4932</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/00000658-198709000-00004</identifier><identifier>PMID: 3307653</identifier><identifier>CODEN: ANSUA5</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject>Biological and medical sciences ; Clinical Trials as Topic ; Gastroenterology. Liver. Pancreas. Abdomen ; Hemodynamics ; Hemorrhage - mortality ; Hemorrhage - surgery ; Hemorrhage - therapy ; Humans ; Liver - blood supply ; Liver - physiopathology ; Liver Cirrhosis - mortality ; Liver Cirrhosis - surgery ; Liver Cirrhosis - therapy ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Medical sciences ; Other diseases. Semiology ; Portasystemic Shunt, Surgical - mortality ; Prospective Studies ; Random Allocation ; Recurrence ; Sclerosing Solutions - therapeutic use ; Splenorenal Shunt, Surgical - mortality ; Varicose Veins - mortality ; Varicose Veins - surgery ; Varicose Veins - therapy</subject><ispartof>Annals of surgery, 1987-09, Vol.206 (3), p.261-271</ispartof><rights>1988 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1493196/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1493196/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,309,310,314,727,780,784,789,790,885,23930,23931,25140,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=7412869$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/3307653$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>RIKKERS, L. F</creatorcontrib><creatorcontrib>BURNETT, D. A</creatorcontrib><creatorcontrib>VOLENTINE, G. D</creatorcontrib><creatorcontrib>BUCHI, K. N</creatorcontrib><creatorcontrib>CORMIER, R. A</creatorcontrib><title>Shunt surgery versus endoscopic sclerotherapy for long-term treatment of variceal bleeding: early results of a randomized trial</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>In September 1982, a prospective randomized trial comparing shunt surgery and endoscopic sclerotherapy for the elective management of variceal hemorrhage in patients with cirrhosis was initiated. Twenty-seven patients have received shunts (distal splenorenal = 23, nonselective = 4) and 30 patients have had chronic sclerotherapy. Eighty-six per cent of patients had alcoholic cirrhosis and 33% were Child's class C. After a mean follow-up of 25 months, 19% of shunt and 57% of sclerotherapy patients have had rebleeding (p = 0.003). Kaplan-Meier survival analysis reveals similar 2-year survival rates for shunt (65%) and sclerotherapy (61%) groups. Only two of 10 sclerotherapy failures have been salvaged by surgery. Posttherapy quantitative hepatic function, frequency of encephalopathy, and cumulative medical costs were similar for both groups. Hepatic portal perfusion and portal pressure at 1 year were better maintained by sclerotherapy than by distal splenorenal shunt. In conclusion, endoscopic sclerotherapy and shunt surgery provide similar results with respect to survival, hepatic function, frequency of encephalopathy, and costs. Sclerotherapy is an acceptable, but not superior, alternative to shunt surgery for treatment of variceal hemorrhage.</description><subject>Biological and medical sciences</subject><subject>Clinical Trials as Topic</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hemodynamics</subject><subject>Hemorrhage - mortality</subject><subject>Hemorrhage - surgery</subject><subject>Hemorrhage - therapy</subject><subject>Humans</subject><subject>Liver - blood supply</subject><subject>Liver - physiopathology</subject><subject>Liver Cirrhosis - mortality</subject><subject>Liver Cirrhosis - surgery</subject><subject>Liver Cirrhosis - therapy</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Medical sciences</subject><subject>Other diseases. 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F</creator><creator>BURNETT, D. A</creator><creator>VOLENTINE, G. D</creator><creator>BUCHI, K. N</creator><creator>CORMIER, R. A</creator><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>19870901</creationdate><title>Shunt surgery versus endoscopic sclerotherapy for long-term treatment of variceal bleeding: early results of a randomized trial</title><author>RIKKERS, L. F ; BURNETT, D. A ; VOLENTINE, G. D ; BUCHI, K. N ; CORMIER, R. A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c434t-a0a1f072db92de1a7eba5a927313c77ee993e4ef6feb5ad66c4267f3958dfae93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1987</creationdate><topic>Biological and medical sciences</topic><topic>Clinical Trials as Topic</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hemodynamics</topic><topic>Hemorrhage - mortality</topic><topic>Hemorrhage - surgery</topic><topic>Hemorrhage - therapy</topic><topic>Humans</topic><topic>Liver - blood supply</topic><topic>Liver - physiopathology</topic><topic>Liver Cirrhosis - mortality</topic><topic>Liver Cirrhosis - surgery</topic><topic>Liver Cirrhosis - therapy</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Medical sciences</topic><topic>Other diseases. Semiology</topic><topic>Portasystemic Shunt, Surgical - mortality</topic><topic>Prospective Studies</topic><topic>Random Allocation</topic><topic>Recurrence</topic><topic>Sclerosing Solutions - therapeutic use</topic><topic>Splenorenal Shunt, Surgical - mortality</topic><topic>Varicose Veins - mortality</topic><topic>Varicose Veins - surgery</topic><topic>Varicose Veins - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>RIKKERS, L. F</creatorcontrib><creatorcontrib>BURNETT, D. A</creatorcontrib><creatorcontrib>VOLENTINE, G. D</creatorcontrib><creatorcontrib>BUCHI, K. N</creatorcontrib><creatorcontrib>CORMIER, R. 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A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Shunt surgery versus endoscopic sclerotherapy for long-term treatment of variceal bleeding: early results of a randomized trial</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>1987-09-01</date><risdate>1987</risdate><volume>206</volume><issue>3</issue><spage>261</spage><epage>271</epage><pages>261-271</pages><issn>0003-4932</issn><eissn>1528-1140</eissn><coden>ANSUA5</coden><abstract>In September 1982, a prospective randomized trial comparing shunt surgery and endoscopic sclerotherapy for the elective management of variceal hemorrhage in patients with cirrhosis was initiated. Twenty-seven patients have received shunts (distal splenorenal = 23, nonselective = 4) and 30 patients have had chronic sclerotherapy. Eighty-six per cent of patients had alcoholic cirrhosis and 33% were Child's class C. After a mean follow-up of 25 months, 19% of shunt and 57% of sclerotherapy patients have had rebleeding (p = 0.003). Kaplan-Meier survival analysis reveals similar 2-year survival rates for shunt (65%) and sclerotherapy (61%) groups. Only two of 10 sclerotherapy failures have been salvaged by surgery. Posttherapy quantitative hepatic function, frequency of encephalopathy, and cumulative medical costs were similar for both groups. Hepatic portal perfusion and portal pressure at 1 year were better maintained by sclerotherapy than by distal splenorenal shunt. In conclusion, endoscopic sclerotherapy and shunt surgery provide similar results with respect to survival, hepatic function, frequency of encephalopathy, and costs. Sclerotherapy is an acceptable, but not superior, alternative to shunt surgery for treatment of variceal hemorrhage.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>3307653</pmid><doi>10.1097/00000658-198709000-00004</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Annals of surgery, 1987-09, Vol.206 (3), p.261-271 |
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| subjects | Biological and medical sciences Clinical Trials as Topic Gastroenterology. Liver. Pancreas. Abdomen Hemodynamics Hemorrhage - mortality Hemorrhage - surgery Hemorrhage - therapy Humans Liver - blood supply Liver - physiopathology Liver Cirrhosis - mortality Liver Cirrhosis - surgery Liver Cirrhosis - therapy Liver. Biliary tract. Portal circulation. Exocrine pancreas Medical sciences Other diseases. Semiology Portasystemic Shunt, Surgical - mortality Prospective Studies Random Allocation Recurrence Sclerosing Solutions - therapeutic use Splenorenal Shunt, Surgical - mortality Varicose Veins - mortality Varicose Veins - surgery Varicose Veins - therapy |
| title | Shunt surgery versus endoscopic sclerotherapy for long-term treatment of variceal bleeding: early results of a randomized trial |
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