Failure of Repeated Injection Sclerotherapy to Improve Long-Term Survival After Oesophageal Variceal Bleeding

Terblanche, J.; Kahn, Delawir; Campbell, JohnA.H.; Bornman, P. C.; Jonker, M.; Wright, John Paul; Kirsch, Ralph E.

doi:10.1016/s0140-6736(83)91090-5

Cited by 300 publications

(81 citation statements)

References 17 publications

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“…This patient was included in the control medical management limb of a previous randomized trial.7 This patient remained well for 7 years after entry into the study and then had a major variceal bleed that could not be controlled by conservative measures. The patient underwent gastroesophageal devascularization, followed by transthoracic esophageal transection for continued variceal bleeding and eventually died as a result of multiorgan failure.…”

Section: Resultsmentioning

confidence: 99%

A 15-Year Experience of Injection Sclerotherapy in Adult Patients with Extrahepatic Portal Venous Obstruction

Kahn

Terblanche²,

Bornman³

et al. 1994

Annals of Surgery

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ObjectiveThe authors report a 15-year experience with injection sclerotherapy in the management of adult and teenage patients with esophageal varices due to extrahepatic portal venous obstruction (EHPVO). Summary Background DataExtrahepatic portal venous obstruction is an uncommon cause of esophageal varices and is associated with normal liver function. Effective control of variceal bleeding is the major factor influencing survival. The results of surgery have been unsatisfactory, and therefore, more conservative management policies have been adopted. MethodsFifty-five patients with proven EHPVO underwent repeated injection sclerotherapy via either a modified rigid esophagoscope under general anaesthesia or a fiber-optic endoscope under light sedation, using ethanolamine oleate as the sclerosant. ResultsEsophageal varices were eradicated in 44 patients after a median number 6 injections (range 1-17) over a mean of 12.5 months (range 1-48). The mean follow-up was 6.8 years (range 1 .1-14.6 years). Eleven patients were admitted on eighteen occasions with bleeding from esophageal varices before eradication and there were seven bleeding episodes in six patients from recurrent varices after initial eradication. Complications related to sclerotherapy included injection site leak (6), stenosis (1 1) and mucosal ulceration (32) during 362 injection sclerotherapy episodes. Four patients died during the study period. ConclusionsInjection scelotherapy is the treatment of choice in most patients with EHPVO.

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Section: Resultsmentioning

confidence: 99%

A 15-Year Experience of Injection Sclerotherapy in Adult Patients with Extrahepatic Portal Venous Obstruction

Kahn

Terblanche²,

Bornman³

et al. 1994

Annals of Surgery

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show abstract

“…There are no data comparing rigid and flexible endoscopes; however, a trial is under way at the University of Capetown [27]. The rigid instrument necessitates general anesthe sia, which may minimize some of the techni cal difficulties of the procedure, and endotra cheal intubation may reduce the risk of aspi ration.…”

Section: Techniques Of Endoscopic Sclerotherapymentioning

confidence: 99%

“…Eradication of esophageal varices is possi ble although the number of injections re quired is variable and depends upon variceal size and extent [27]. No standard schedule of procedures is followed by all investigators.…”

Section: Techniques Of Endoscopic Sclerotherapymentioning

confidence: 99%

“…41, 43, 47, 49], Re peat procedures are performed until variceal obliteration occurs. Once eradicated, the esophagus may remain varix-free for ex tended periods (mean 21.5 months), al though varices recur in most patients [27], Therefore, lifelong endoscopic surveillance for recurrent varices and subsequent reinjec tion is mandatory to minimize the risk of rebleeding. Annual endoscopic follow-up has been recommended [27],…”

Section: Techniques Of Endoscopic Sclerotherapymentioning

confidence: 99%

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Endoscopic Sclerosis of Esophageal Varices

Foutch¹,

Fleischer²,

Sivak³

1984

Dig Dis

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“…It is rather disappointing for us surgeons that sclerotherapy has not been successful in many of the poor risk patients in whom operation can not be tolerated. Reports of prophylactic controlled studies with sclerotherapy are accumulating, [13][14][15][16][17][18][19] but the results have not been unanimous, and therefore not convincing.…”

mentioning

confidence: 99%