Endoscopic sclerotherapy versus esophageal transection in Child's class C patients with variceal hemorrhage. Comparison with results of portacaval shunt: Preliminary report

John P. Cello, Richard Crass, Donald Trunkey

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Thirteen Child's class C patients with variceal hemorrhage requiring 6 or more units of blood were randomly assigned to groups receiving either flexible endoscopic sclerotherapy using 5% sodium morrhuate or esophageal transection/reanastomosis employing the EEA Auto Suture stapling instrument. One patient with a previous hiatus hernia repair was assigned to the transection group and had a mesocaval shunt. The randomization groups compared favorably with each other and with a retrospective shunt group (20 patients). Although transection patients required significantly less operative time and fewer blood transfusions, the outcome of the transection group was significantly worse than that of the shunt group. The trend in survival likewise favored the shunt group rather than the sclerotherapy group. Although the reported operative mortality rates of transection and sclerotherapy are less than that of portal decompression, the results of this study-the first controlled trial of these procedures-would warrant distinct caution in using either of these new techniques in high-risk patients. Portal decompression may still be the procedure of choice in class C patients with substantial variceal hemorrhage.

Original languageEnglish (US)
Pages (from-to)333-338
Number of pages6
JournalSurgery
Volume91
Issue number3
StatePublished - 1982
Externally publishedYes

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Surgical Portacaval Shunt
Sclerotherapy
Hemorrhage
Decompression
Sodium Morrhuate
Hiatal Hernia
Herniorrhaphy
Operative Time
Random Allocation
Blood Transfusion
Sutures
Survival
Mortality

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Endoscopic sclerotherapy versus esophageal transection in Child's class C patients with variceal hemorrhage. Comparison with results of portacaval shunt: Preliminary report",
abstract = "Thirteen Child's class C patients with variceal hemorrhage requiring 6 or more units of blood were randomly assigned to groups receiving either flexible endoscopic sclerotherapy using 5{\%} sodium morrhuate or esophageal transection/reanastomosis employing the EEA Auto Suture stapling instrument. One patient with a previous hiatus hernia repair was assigned to the transection group and had a mesocaval shunt. The randomization groups compared favorably with each other and with a retrospective shunt group (20 patients). Although transection patients required significantly less operative time and fewer blood transfusions, the outcome of the transection group was significantly worse than that of the shunt group. The trend in survival likewise favored the shunt group rather than the sclerotherapy group. Although the reported operative mortality rates of transection and sclerotherapy are less than that of portal decompression, the results of this study-the first controlled trial of these procedures-would warrant distinct caution in using either of these new techniques in high-risk patients. Portal decompression may still be the procedure of choice in class C patients with substantial variceal hemorrhage.",
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T1 - Endoscopic sclerotherapy versus esophageal transection in Child's class C patients with variceal hemorrhage. Comparison with results of portacaval shunt

T2 - Preliminary report

AU - Cello, John P.

AU - Crass, Richard

AU - Trunkey, Donald

PY - 1982

Y1 - 1982

N2 - Thirteen Child's class C patients with variceal hemorrhage requiring 6 or more units of blood were randomly assigned to groups receiving either flexible endoscopic sclerotherapy using 5% sodium morrhuate or esophageal transection/reanastomosis employing the EEA Auto Suture stapling instrument. One patient with a previous hiatus hernia repair was assigned to the transection group and had a mesocaval shunt. The randomization groups compared favorably with each other and with a retrospective shunt group (20 patients). Although transection patients required significantly less operative time and fewer blood transfusions, the outcome of the transection group was significantly worse than that of the shunt group. The trend in survival likewise favored the shunt group rather than the sclerotherapy group. Although the reported operative mortality rates of transection and sclerotherapy are less than that of portal decompression, the results of this study-the first controlled trial of these procedures-would warrant distinct caution in using either of these new techniques in high-risk patients. Portal decompression may still be the procedure of choice in class C patients with substantial variceal hemorrhage.

AB - Thirteen Child's class C patients with variceal hemorrhage requiring 6 or more units of blood were randomly assigned to groups receiving either flexible endoscopic sclerotherapy using 5% sodium morrhuate or esophageal transection/reanastomosis employing the EEA Auto Suture stapling instrument. One patient with a previous hiatus hernia repair was assigned to the transection group and had a mesocaval shunt. The randomization groups compared favorably with each other and with a retrospective shunt group (20 patients). Although transection patients required significantly less operative time and fewer blood transfusions, the outcome of the transection group was significantly worse than that of the shunt group. The trend in survival likewise favored the shunt group rather than the sclerotherapy group. Although the reported operative mortality rates of transection and sclerotherapy are less than that of portal decompression, the results of this study-the first controlled trial of these procedures-would warrant distinct caution in using either of these new techniques in high-risk patients. Portal decompression may still be the procedure of choice in class C patients with substantial variceal hemorrhage.

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