A Prospective Study of Esophageal Variceal Recurrence and Rebleed Rates after Primary Eradication
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2017, Vol 5, Issue 6
Abstract
Introduction: Variceal bleeding is a life-threatening complication of portal hypertension with a high probability of recurrence. Treatment to prevent first bleeding or rebleeding is mandatory. Aim: The aim of this study is to evaluate prospectively the overall long-term clinical outcome in terms of recurrence of varices and rebleed rates after eradication of varices following endoscopic sclerotherapy (EST) in consecutively treated cirrhotic patients with bleeding esophageal varices. Materials and Methods: Consecutive patients presenting with bleeding esophageal varices for the first time and registered in the liver clinic of the institution were included in the study. Those patients with an earlier variceal bleed and on EST schedule, initiated elsewhere, were excluded from the study. Child C patients who failed to recover and presented with variceal bleed were also excluded. Results: A total of 133 consecutive patients were treated for esophageal variceal bleeding, there were 86 men and 47 women (mean age: 45.51 + 11.8 years; age range, 20-77 years). A total of 611 EST sessions were performed with a mean of 4.6 injections. 43 (32.3%) of the 133 patients continued to have recurrent bleed in between the EST sessions and eradication of varices. 16 (12%) patients died within 3 months of registration, 8 from massive GI bleed, 4 from hepatic encephalopathy, 2 from hepatorenal syndrome, and 2 from spontaneous bacterial peritonitis. They had overall 28 EST sessions with a mean of 1.8 injections. Conclusion: Ultimately, the use of sequential combined endoscopic techniques with variceal banding initially when varices are large followed by sclerotherapy when varices are small may enhance the endoscopic management of esophageal varices in terms of reducing complications, facilitating earlier eradications, and preventing recurrence.
Authors and Affiliations
R Selvasekaran, Heber Anandan
Keywords
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