Alcoholic versus nonalcoholic cirrhosis in a randomized controlled trial of emergency therapy of bleeding varices

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

2 Scopus citations

Abstract

Background: It has been proposed that portal-systemic shunts be avoided in alcoholic cirrhotics because survival rate is allegedly lower in alcoholics than in nonalcoholics. We examined this issue in a randomized controlled trial. Methods: Two hundred eleven unselected, consecutive patients with cirrhosis and bleeding esophageal varices were randomized to endoscopic sclerotherapy (EST) (n = 106) or emergency portacaval shunt (EPCS) (105). Treatment was initiated within 8 h. EST failure was treated by rescue portacaval shunt (PCS). Ten-year follow-up was 96%. Results: Results strongly favored EPCS over EST (P < 0.001). Among EPCS patients, 83% were alcoholic and 17% nonalcoholic. Outcomes were (1) permanent control of bleeding 100% versus 100%; (2) 5-y survival 71% versus 78%; (3) encephalopathy 14% versus 19%; (4) yearly charges $38,300 versus $43,000. Conclusions: EPCS results were similar in alcoholic and nonalcoholic cirrhotics. EPCS is an effective first line emergency treatment in all forms of cirrhosis, including alcoholic.

Original languageEnglish (US)
Pages (from-to)98-105
Number of pages8
JournalJournal of Surgical Research
Volume174
Issue number1
DOIs
StatePublished - May 1 2012

Keywords

  • alcoholic
  • bleeding esophageal varices
  • cirrhosis
  • emergency portacaval shunt
  • endoscopic sclerotherapy
  • nonalcoholic

ASJC Scopus subject areas

  • Surgery

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  • Cite this

    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). Alcoholic versus nonalcoholic cirrhosis in a randomized controlled trial of emergency therapy of bleeding varices. Journal of Surgical Research, 174(1), 98-105. https://doi.org/10.1016/j.jss.2010.11.007