Document Detail


Alcoholic versus nonalcoholic cirrhosis in a randomized controlled trial of emergency therapy of bleeding varices.
MedLine Citation:
PMID:  21195430     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: It has been proposed that portal-systemic shunts be avoided in alcoholic cirrhotics because survival rate is allegedly lower in alcoholics than in nonalcoholics. We examined this issue in a randomized controlled trial.
METHODS: Two hundred eleven unselected, consecutive patients with cirrhosis and bleeding esophageal varices were randomized to endoscopic sclerotherapy (EST) (n = 106) or emergency portacaval shunt (EPCS) (105). Treatment was initiated within 8 h. EST failure was treated by rescue portacaval shunt (PCS). Ten-year follow-up was 96%.
RESULTS: Results strongly favored EPCS over EST (P < 0.001). Among EPCS patients, 83% were alcoholic and 17% nonalcoholic. Outcomes were (1) permanent control of bleeding 100% versus 100%; (2) 5-y survival 71% versus 78%; (3) encephalopathy 14% versus 19%; (4) yearly charges $38,300 versus $43,000.
CONCLUSIONS: EPCS results were similar in alcoholic and nonalcoholic cirrhotics. EPCS is an effective first line emergency treatment in all forms of cirrhosis, including alcoholic.
Authors:
Marshall J Orloff; Jon I Isenberg; Henry O Wheeler; Kevin S Haynes; Horacio Jinich-Brook; Roderick Rapier; Florin Vaida; Robert J Hye; Susan L Orloff
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2010-12-03
Journal Detail:
Title:  The Journal of surgical research     Volume:  174     ISSN:  1095-8673     ISO Abbreviation:  J. Surg. Res.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-03-28     Completed Date:  2012-05-14     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  0376340     Medline TA:  J Surg Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  98-105     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Department of Surgery, University of California, San Diego Medical Center, 200West Arbor Drive, San Diego, CA 92103-8999, USA. morloff@ucsd.edu
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MeSH Terms
Descriptor/Qualifier:
Emergency Treatment* / economics
Endoscopy
Esophageal and Gastric Varices / mortality,  therapy*
Gastrointestinal Hemorrhage / mortality,  therapy*
Health Care Costs
Humans
Liver Cirrhosis / complications*
Liver Cirrhosis, Alcoholic / complications*
Portasystemic Shunt, Transjugular Intrahepatic
Sclerotherapy
Grant Support
ID/Acronym/Agency:
1R01DK41920/DK/NIDDK NIH HHS; R01 DK041920-07/DK/NIDDK NIH HHS
Comments/Corrections

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