Does elective sclerotherapy improve the efficacy of long-term propranolol for prevention of recurrent bleeding in patients with severe cirrhosis? A prospective multicenter, randomized trial
✍ Scribed by Olivier Ink; Thierry Martin; Thierry Poynard; Marc Reville; Marie-Laure Anciaux; Claude Lenoir; Jean-Luc Marill; Hélène Labadie; Claude Masliah; Daniel Perrin; Jean-Claude Chaput; Denis Vetter; Claude Eugene; Louis Lebodic; Henri Licht; Jean-Pierre Etienne
- Publisher
- John Wiley and Sons
- Year
- 1992
- Tongue
- English
- Weight
- 931 KB
- Volume
- 16
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
We conducted a prospective, multicenter, randomized trial to compare the efficacy of sclerotherapy plus propranolol with that of propranolol alone in the prevention of recurrent gastroesophageal bleeding in severely cirrhotic patients. For 2 yr (1987 to 1988) 131 patients (96% of whom were alcoholic) with Child-Pugh class B or C cirrhosis (66% were class B and 44% were class C) were randomly assigned to one of our two treatment groups after cessation of variceal bleeding, without hemostatic sclerosis, and were observed for at least 2 yr. Treatment observance was good in 89% of cases; alcohol withdrawal was observed in 62% of cases. Sclerotherapy was performed weekly with 1% polidocanol, and variceal obliteration was obtained in 83% of cases, in a mean number of four sessions. The cumulative percentages (expressed as mean f S.D.) of recurrent bleeding at 2 yr were 42% f 6% for propranolol plus sclerotherapy and 69% f 6% for propranolol alone (a nonsignificant difference). Twentyeight patients from the propranolol group but only 12 patients from the propranolol-plus-sclerotherapy group had recurrent bleeding from esophageal variceal rupture (p c 0.01). The total number of blood units per patient with recurrent bleeding was slightly but not significantly more important in the propranolol group (8 f 7) than in the propranolol-plus-sclerotherapy group (6 f 5; p = 0.09). There were no statistical differences in the cumulative survival rate at 2 yr (propranolol plus sclerotherapy, 74% f 6% and propranolol alone, 64% f 6%) or in the number of patients who died of repeat bleeding (propranolol plus sclerotherapy, 13% f 4% and propranolol alone, 17% f 5%). Among