A randomized controlled trial of emergency treatment of bleeding esophageal varices in cirrhosis for hepatocellular carcinoma

Marshall J. Orloff, Jon I. Isenberg, Henry O. Wheeler, Kevin S. Haynes, Horacio Jinich-Brook, Roderick Rapier, Florin Vaida, Robert J. Hye, Susan L. Orloff

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Background: Ninety percent of patients with hepatocellular carcinoma (HCC) have cirrhosis. Bleeding esophageal varices (BEV) is a frequent complication of cirrhosis. Detection of HCC in cirrhotic patients with BEV has not been studied. Methods: Two hundred eleven unselected patients with cirrhosis and BEV were randomized to endoscopic sclerotherapy (n = 106) or emergency portacaval shunt (n = 105). Diagnostic workup and treatment were initiated within 8 hours. Ninety-six percent had >10 years of follow-up. HCC screening involved serum α-fetoprotein (AFP) every 3 months, ultrasonography every 6 months, and selective computed tomography (CT). Results: HCC occurred in 15 patients, all incurable, a mean of 2.94 years after entry. They died a mean 1.33 years after discovery. Serial AFP and ultrasound examinations were unrevealing over a mean of 2.3 years. The mean model of end-stage liver disease score was 12.7 at entry and 17.4 at HCC diagnosis. Conclusions: Long-term screening by AFP and ultrasound plus selective CT failed to detect HCC at a curable stage. The detection of HCC in cirrhotic patients with BEV remains a serious, unsolved problem. The use of CT for routine screening warrants consideration despite increased costs.

Original languageEnglish (US)
Pages (from-to)182-190
Number of pages9
JournalAmerican journal of surgery
Volume203
Issue number2
DOIs
StatePublished - Feb 2012

Keywords

  • Bleeding esophageal varices
  • Cirrhosis
  • Emergency portacaval shunt
  • Endoscopic sclerotherapy
  • Hepatocellular carcinoma (HCC)
  • Screening for HCC

ASJC Scopus subject areas

  • Surgery

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    Orloff, M. J., Isenberg, J. I., Wheeler, H. O., Haynes, K. S., Jinich-Brook, H., Rapier, R., Vaida, F., Hye, R. J., & Orloff, S. L. (2012). A randomized controlled trial of emergency treatment of bleeding esophageal varices in cirrhosis for hepatocellular carcinoma. American journal of surgery, 203(2), 182-190. https://doi.org/10.1016/j.amjsurg.2011.02.007