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Sclerotherapy Versus Transection for Acute Variceal Bleeding

HPB Surgery
Hindawi Publishing Corporation
Publication Date
DOI: 10.1155/1994/86120
  • Research Article
  • Medicine


HPB Surgery, 1994, Vol. 7, pp. 327-340 Reprints available directly from the publisher Photocopying permitted by license only (C) 1994 Harwood Academic Publishers GmbH Printed in the United States of America HPB INTERNATIONAL EDITORIAL & ABSTRACTING SERVICE JOHN TERBLANCHE, EDITOR Department of Surgery, Medical School Observatory 7925 Cape Town South Africa Telephone: (021) 406-6232 Telefax (021) 448-6461 SCLEROTHERAPY VERSUS TRANSECTION FOR ACUTE VARICEAL BLEEDING ABSTRACT Burroughs, A.K., Hamilton, G. Phillips, A., Mezzanotte, G., Mclntyre, N. and Hobbs, K.E.F. (1989) A comparison of sclerotherapy with staple transection of the esophagus for the emergency control of bleeding from esophagus varices. The New England Journal of Medicine; 321:857-862 We compared two procedures for the emergency treatment of bleeding esophageal varices in patients who did not respond to blood transfusion and vasoactive drugs. We randomly assigned 101 patients with cirrhosis of the liver and bleeding esopha- geal varices to undergo either emergency sclerotherapy (n 50) or staple transec- tion of the esophagus (n 51). Four patients assigned to sclerotherapy and 12 assigned to staple transection did not actually undergo those procedures, but all analyses were made on an intention-to-treat basis. Total mortality did not differ significantly between the two groups; the relative risk of death for staple transection as compared with sclerotherapy was 0.88 (95 percent confidence interval, 0.51 to 1.54). Mortality at six weeks was 44 percent among those assinged to sclerotherapy and 35 percent among those assigned to staple transection. Complication rates were similar for the two groups. An interval of five days without bleeding was achieved in 88 percent of those assigned to staple transection and in 62 percent of those assinged to sclerotherapy after a single injection (P 0.01) and 82 percent after three injections. In only 2 of the 11 patients who received a third sclerotherapy injection was bleeding co

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