A comparative study of the elective treatment of variceal hemorrhage with β-blockers, transendoscopic sclerotherapy, and surgery : A prospective, controlled, and randomized trial during 10 years

• Published in: Annals of surgery 2000-08, Vol.232 (2), p.216-219
• Main Authors: OROZCO, H, MERCADO, M. A, CHAN, C, GUILLEN-NAVARRO, E, LOPEZ-MARTINEZ, L. M
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; Biological and medical sciences; Endoscopy; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Hypertension, Portal - complications; Hypertension, Portal - therapy; Male; Medical sciences; Middle Aged; Original; Other diseases. Semiology; Propranolol - therapeutic use; Prospective Studies; Sclerotherapy - methods; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Tropical medicine; Varicose Veins - etiology; Varicose Veins - therapy
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-200008000-00011

To compare three options for the elective treatment of portal hypertension during a 10-year period. Patients included in the trial were 18 to 76 years old, had a history of bleeding portal hypertension, and had undergone no prior treatment. Treatment options were beta-blockers (propranolol), sclerotherapy, and portal blood flow-preserving procedures (selective shunts and the Sugiura-Futagawa operation). A total of 119 patients were included: 40 in the pharmacology group, 46 in the sclerotherapy group,and 33 in the surgical group. The three groups showed no differences in terms of age, Child-Pugh classification, and cause of liver disease. The rebleeding rate was significantly lower in the surgical group than in the other two groups. The rebleeding rate was only 5% in the Child A surgical group, compared with 71% and 68% for the sclerotherapy and pharmacotherapy groups, respectively. Survival was better for the low-risk patients (Child A) in the three groups, but when the three options were compared, no significant difference was found. Portal blood flow-preserving procedures offer the lowest rebleeding rate in low-risk patients undergoing elective surgery.