Complications and long term prognosis of endoscopic injection sclerotherapy for esophageal varices
Gastroenterological Endoscopy 32(6): 1321-1331
Endoscopic injection sclerotherapy (EIS) using 1% Polidocanol was performed in 105 patients with esophageal varices from Jul. 1983 to Sep. 1989. Of them, 24 had paravariceal injection (PVI) in the earlier series and 81 had para- and intravariceal injection (PVI+IVI) in the later series. In this study, prognosis and complications of EIS were evaluated. Concerning the bleeding rate from varices after complete EIS, PVI+IVI(2.6%) was significantly excellent compared with PVI(26%) (p < 0.01). Major complications occurred in 7 cases (7%), and minor ones in 64 cases (61%). Two patients with hepatocellular carcinoma (HCC) associated with late stage of liver cirrhosis died due to major complications. In prognosis after EIS, there was no difference on long-term survival rate in emergent, elective, or prophylactic conditions. The differences between survival rates of A and B according to the Child's classification was noted statistically significant (p < 0.01), and the differences betewen A and C (p < 0.001). The difference between B and C was also statistically noted (p < 0.01) only at 2 years and 9 months after EIS. In addition, the difference between liver cirrhosis with and without HCC was statistically significant. When cases of HCC was excluded, the difference between survival rates of B and C was not significant. In conclusion, EIS, especially by PVI+IVI, was very useful to treat esophageal varices in any condition including liver cirrhosis at a rather late stage according to Child's classification except cases of HCC.