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Background. Sclerotherapy is usually effective in controling acutely bleeding esophageal varices.
It may not be as effective as shunt surgery for prevention of rebleeding; therefore
we undertook a prospective study comparing interposition mesocaval shunt (MSC) and
repeated sclerotherapy.
Methods. Forty-five patients (mean age, 52.6±9.8 years) with variceal bleeding were randomized
after emergency endoscopic sclerotherapy either to repeat variceal obliteration followed
by regular check endoscopy (n=21) or to elective interposition mesocaval shunting
by use of 14 mm polytetrafluoroethylene graft (n=24). There was an equal distribution
of Child's classes in the two groups.
Results. In the sclerotherapy group 12 patients had recurrent hemorrhages causing five deaths
compared with the shunt group, in which four patients had postoperative bleeding but
without associated death. No difference was noted in the incidence of encephalopathy
despite the development of total shunting 1 year after MCS. The median hospital stay
was similar; 34.5 days (MCS) and 33 days (sclerotherapy). The number of intensive
care unit days was also similar in the two groups. No difference was noted in survival
in patients with Child's A and Child's B disease in the treatment groups. In patients
with Child's C cirrhosis there was a statistically significant longer survival in
patients underoing MCS compared with patients undergoing sclerotherapy.
Conclusions. The results of the study show that the rate of rebleeding is significantly higher
after sclerotherapy than after mesocaval shunting. In patients with Child's C cirrhosis
MCS may be an alternative to sclerotherapy for the prevention of rebleeding from esophageal
varices in patients not suitable for transplantation.
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Article info
Publication history
Accepted:
October 17,
1994
Footnotes
*Supported by grant nr 4X-9489 from the Swedish Medical Research Council.
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
