Esophageal staple transection as a salvage procedure after failure of acute injection sclerotherapy
✍ Scribed by Dr. P. Aiden McCormick; Graham L. Kaye; Lynda Greenslade; Fabrizio Cardin; Kenneth E. F. Hobbs; Neil McIntyre; Andrew K. Burroughs
- Publisher
- John Wiley and Sons
- Year
- 1992
- Tongue
- English
- Weight
- 513 KB
- Volume
- 15
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
It is not clear which therapy should be used in patients with bleeding esophageal varices that are not controlled by emergency sclerotherapy. This is a high-risk group with reported mortality rates of between 70% and 90%. We report our 7-yr experience with staple transection of the esophagus in this patient group. Of 168 patients (280 bleeding episodes) treated with sclerotherapy, 22 had emergency staple transection for failure to control bleeding. Bleeding was controlled in 20 patients (90%), and 10 patients (45%) survived to leave the hospital, including 4 of 10 patients (40%) with Pugh grade C liver disease. We suggest that emergency staple transection is an effective salvage treatment for this high-risk group. (HEPATOLOGY 1992; 15:403-406.)
Injection sclerotherapy of esophageal varices is an effective treatment for acute variceal bleeding (1-4). Bleeding is controlled in 70% of cases after one injection and in 80% to 90% of cases after two injections (1). If bleeding continues, further injections appear to be of little extra benefit (5). The subgroup of patients who continue t o bleed has a poor prognosis, with a mortality rate approaching 90% for patients with Child class B and C liver disease (6). Bleeding can be temporarily controlled at this stage with balloon tamponade before a major surgical procedure (1, 7). However, few data exist to indicate which surgical procedure t o use (8). We present our 7-yr experience with emergency esophagogastric staple transection in patients who continue t o bleed despite treatment with endoscopic sclerotherapy.
PATIENTS AND METHODS
Between June 1983 and June 1990,372 patients with a total of 655 bleeding episodes were admitted to the Hepatobiliary and Liver Transplantation Unit of the Royal Free Hospital with bleeding esophageal varices. They were cared for by a joint medical-surgical team, and all information was collected prospectively as part of a project designed to predict prognosis