Is there an Indication for Prophylactic Endoscopic Paravariceal Injection Sclerotherapy in Patients with Liver Cirrhosis and Portal Hypertension?

Summary

From January 1, 1978, to January 1, 1980, a prospective controlled randomized trial comparing conservative treatment to prophylactic endoscopic paravariceal injection sclerotherapy of esophageal varices prior to hemorrhage was carried out. In all 71 patients liver cirrhosis was confirmed histologically. The two randomly assigned groups were comparable with respect to age, sex and degree of liver diseases and its histological type was also similar. Indications for endoscopic treatment were the existence of degree III to IV varices bearing telangiectasias on their top, and degree II to IV varices without telangiectasias but coagulation factors below 30 %, or both. Six patients had to be excluded. In group 1 A - treatment by conservative means, clinical and endoscopic monitoring - a high rate of variceal bleeding (66 %) and death (42 %) was observed. Comparing these results with those of group I B treated by sclerotherapy, bleeding and death rates (6 and 6 %) were found to be highly significantly lower. From January 1, 1980, to January 1, 1984 another 70 non-randomized patients were treated by prophylactic endoscopic paravariceal injection sclerotherapy. In this group II the frequency of hemorrhage was 4.5 % and in-hospital mortality 13 %. The main causes of death were hepatic coma, followed by hemorrhage from esophageal varices. After four years another 14 patients had died despite regular monitoring and re-injection (20 %); the main causes of death were hepatic coma and hepatocellular cancer. Five patients (7 %) were lost to follow up, while 42 (60 %) are still living. - Thus prophylactic endoscopic paravariceal injection sclerotherapy in esophageal degree III-IV varices with telangiectasias and/or poor coagulation reserves of the liver can largely prevent an esophageal variceal hemorrhage, and is able to prolong the life of these chronically ill patients to an appreciable extent.

Key words:

Classification of varices - Prophylactic paravariceal injection of the esophageal wall - Esophageal varices - High-risk patient - Prospective controlled randomized trial