Système gastro-intestinal et digestif

Abstrait

Long-term Results of Radiologically Guided Endoscopic Injection Sclerotherapy for Esophageal Variceal Bleeding: A Retrospective 30-year Survey

Hiroaki Iwase, Masaaki Shimada, Noboru Hirashima, Masayuki Okeya, Nobumitsu Ryuge, Yuichi Kida, Masaya Esaki, Bunichiro Kato and Noboru Urata

Background: Endoscopic injection sclerotherapy (EIS) is one of the most commonly applied techniques in the treatment of patients with bleeding esophageal varices (EV). However, the role of EIS in the long-term management of patients with EV bleeding remains controversial. We conducted a retrospective 30-year survey of EIS in patients with EV bleeding.

Patients and Methods: Sclerosant with radiological contrast agent was endoscopically injected into the distal EV under fluoroscopic observation. The endpoint of injection was to fill the EV, including the supplying venous complex, which comprises the left and the short gastric veins.

Results: Of the 367 patients reviewed, 350 had liver cirrhosis and 17 had idiopathic portal hypertension. The Child-Pugh classification was A in 92 patients, B in 121, and C in 154. Fifty-seven patients had hepatocellular carcinoma (HCC) at the initial EIS. The primary successful hemostasis rate was 95.5%. The numbers of re-bleeding EV episodes were 61 at 0 to 1 year, 34 at 1 to 3 years, 21 at 3 to 6 years, 2 at 6 to 9 years, and 0 over 10 years from the initial EIS intervention. EV was eradicated in 87% of patients and re-bleeding EV was markedly reduced after eradication of EV. Complications were generally mild, serious events were rare after 2000, included renal failure (3.3%), liver failure (3.3%), and esophageal stricture, and shock (1.6%), esophageal ulcer bleeding (1.6%). The causes of death were established in 278 patients, included liver failure (51.8%), HCC (20.9%), bleeding EV (7.9%), and procedure-related mortality (4.3%). The median survival time for all patients was 3.3 years, while 1-, 10-, 20-, and 30-year cumulative survival rates were 72.8%, 7.8%, 3.2%, and 3.2%, respectively.

Conclusion: Our EIS treatment for bleeding EV was effective in reducing bleeding death over the long term. Improved survival requires amelioration of liver function and control of HCC.