Endoscopic Sclerotherapy versus Port Acaval Shunt in Patients with Severe Cirrhosis and Acute Variceal Hemorrhage

John P. Cello, James H. Grendell, Richard A. Crass, Thomas E. Weber, Donald D. Trunkey

    Research output: Contribution to journalArticle

    208 Scopus citations

    Abstract

    In a continuation of a trial for which preliminary results were reported in the Journal two years ago, a total of 64 patients with Child Class C cirrhosis and variceal hemorrhage requiring six or more units of blood were randomly assigned to receive either a portacaval shunt (32 patients) or endoscopic sclerotherapy (32 patients). The duration of initial hospitalization and the total amount of blood transfused during hospitalization were significantly less in the patients receiving sclerotherapy (P<0.001). There was no difference in short-term survival (50 percent of the sclerotherapy group were discharged alive, as compared with 44 percent of the shunt-surgery group). Both groups were followed for a mean of 530 days after randomization. Rebleeding from varices, the duration of rehospitalization for hemorrhage, and transfusions received after discharge were all significantly greater in the sclerotherapy group (P<0.001). Forty percent of the sclerotherapy-treated patients discharged alive (7 of 16 patients) ultimately required surgical treatment for bleeding varices, despite a mean of 6.1 treatment sessions. Health care costs and long-term survival did not differ significantly between the groups (P>0.05). We conclude that although endoscopic sclerotherapy is as good as surgical shunting for the acute management of variceal hemorrhage in poor-risk patients with massive bleeding, sclerotherapy-treated patients in whom varices are not obliterated and bleeding continues should be considered for elective shunt surgery. (N Engl J Med 1987; 316:11–5.), PREVIOUSLY, we reported the preliminary results of a randomized trial comparing endoscopic sclerotherapy with portacaval shunt surgery for active variceal hemorrhage in patients with Child Class C cirrhosis.1 In that study, the 28 patients assigned to sclerotherapy required less operative time and less blood during their initial hospitalization than the 24 assigned to emergency therapeutic portacaval shunt. However, there was no difference in hospital mortality; less than 50 percent of the patients in either group were discharged alive after the index hospitalization. Among the patients who were discharged alive and followed for a mean of 263 days after randomization, those…

    Original languageEnglish (US)
    Pages (from-to)11-15
    Number of pages5
    JournalNew England Journal of Medicine
    Volume316
    Issue number1
    DOIs
    StatePublished - Jan 1 1987

    ASJC Scopus subject areas

    • Medicine(all)

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