In 1939, Crafoord and Frenckner originally reported the sucessful use of endoscopic sclerotherapy by paravasal injection of quinine as a sclerosant to control acute variceal bleeding of a 16-year-old girl.
After the introduction of shunt operation as a treatment of acute variceal bleeding, the endoscopic sclerotherapy became less adoptable for a while.
But since 1970, with the development of the technique, equipments and newer sclerosants, endoscopic sclerotherapy became favorable as a treatment of acute variceal bleeding. Since 1980 in Korea, endoscopic sclerotherapy as a treatment of acute
variceal
bleeding has been practived in many clinics. However, there are few reports of the prognosis and survival rates of the patients who received endoscopic sclerotherapy, and there are many differences among those reports.
Now we report the results of the clinical observation and the survival rates of 125 patients who have been followed for several years(from June 1985 to June 1991) by the Department of Interal Medicine, Paik Hospital, Inje University, Pusan.
@ES The results are as follows:
@EN 1. 125 patients(103 male and 22 female)with bleeding esophageal varices were treated by endoscopic sclerotherapy and followed over a period ranging 3~6 years. Among them, 24 patients were Child class A, 43 Child class B and 58 Child class C.
In
the
degrees of varices, 65 patients showed grade III and 56 patients grade IV respectively, accounting for 97% of all patients.
2. The most prevalent underlying disease was post-necrotic liver cirrhosis in 84 patients, alcoholic liver cirrhosis in 12 patients, chronic active hepatitis in 4, idiopathic portal hypertension in 4 and unknown in 10 patients.
3. Variceal rebleeding after sclerotherapy occurred in 51 patients (40.8%); rebleeding occurred within 6 months in 20 patients(16.0%), and after 6 months in 31 patients(24.8%).
4. Complications after slcerotherapy occurred in 16 patients (1.28%); pneumonia 6 patients, esophageal ulcer 4, esophageal stricture 3, and mediastinitis 3 patients.
5. Fifty-four patients(43.3%) were dead during the clinical observation period: 24 patients (19.2%) were died within 1 month after sclerotherapy, and 30 patients (24.0%) after 1 month. The most prevalent cause of death was hepatic failure
accounting
for half of all deaths.
6. The survival rate of the patients who were treated with sclerotherapy was calculated by Kaplan-Meier method. One year survival rate was 75%, 5 year survival rate was 40%. Patients in the Child grade A and B showed much higher survival rate
than
the
patients in the Child grade C.
7. With our experience, one third of the patients died within 2 years after sclerotherapy and another one third died in 2-5 year after sclerotherapy, but the rest one third survived mostly over 5 years after clerotherapy.
In conclusion, endoscopic sclerotherapy of the aucte variceal bleeding shows still higher frequency of ariceal rebleeding and does no affect the overall mortality rate, but endoscopic sclerotherapy is estimated to be an excellent method of choice
in
treatment of acute variceal bleeding with its excellent hemostatic effect and less side effects.
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