| Endoscopic variceal sclerosis compared with distal splenorenal shunt to prevent recurrent variceal bleeding in cirrhosis. A prospective, randomized trial. | |
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MedLine Citation:
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PMID: 2404448 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: To define the roles of endoscopic variceal sclerosis and distal splenorenal shunt in the prevention of recurrent variceal bleeding in patients with cirrhosis. DESIGN: A prospective, randomized clinical trial with crossover for those failing therapy. The median follow-up was 61 months. SETTING: A private, tertiary-referral university hospital. PATIENTS: Seventy-two patients fulfilling inclusion criteria were drawn from a total of 420 patients treated during a 4.5-year interval. TREATMENTS: Endoscopic variceal sclerosis or distal splenorenal shunt. MEASUREMENTS and MAIN RESULTS: Survival was significantly (P = 0.02) improved in patients randomly assigned to receive sclerotherapy: 13 of these 37 (35%) patients failed sclerotherapy and required surgical rescue. A survival advantage (P = 0.01) was seen in patients with alcoholic cirrhosis who had this combined therapy; however, in patients with nonalcoholic cirrhosis, survival for those receiving sclerotherapy and surgical rescue was not significantly (P = 0.36) different from that of patients receiving distal splenorenal shunt. Control of variceal bleeding was significantly (P less than 0.001) better in the distal splenorenal shunt group (34 of 35 [97%] compared with 15 of 37 [41%] in the sclerotherapy group). Using death, uncontrolled rebleeding, or shunt thrombosis as the endpoints resulted in no significant difference between treatment groups. Hepatocyte function and portal perfusion were significantly better maintained in patients with alcoholic cirrhosis who were managed by sclerotherapy rather than shunt (P = 0.01 and P = 0.001, respectively). CONCLUSIONS: Endoscopic sclerotherapy with surgical rescue for uncontrolled bleeding is the optimum therapy for patients with alcoholic cirrhosis and variceal bleeding. Survival is similar in nonalcoholic patients treated with either distal splenorenal shunt or endoscopic sclerotherapy, but shunting provides better control of variceal bleeding. |
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Authors:
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J M Henderson; M H Kutner; W J Millikan; J T Galambos; S P Riepe; W S Brooks; F C Bryan; W D Warren |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Annals of internal medicine Volume: 112 ISSN: 0003-4819 ISO Abbreviation: Ann. Intern. Med. Publication Date: 1990 Feb |
Date Detail:
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Created Date: 1990-02-21 Completed Date: 1990-02-21 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 262-9 Citation Subset: AIM; IM |
Affiliation:
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Emory University Hospital, Atlanta, Georgia. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Endoscopy Esophageal and Gastric Varices / mortality, physiopathology, prevention & control, therapy* Follow-Up Studies Gastrointestinal Hemorrhage / mortality, physiopathology, prevention & control, therapy* Hemodynamics Humans Liver Cirrhosis / complications* Prognosis Prospective Studies Recurrence Sclerosing Solutions / therapeutic use* Splenorenal Shunt, Surgical* |
| Grant Support | |
ID/Acronym/Agency:
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5M01-RR-00039/RR/NCRR NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Sclerosing Solutions |
| Comments/Corrections | |
Comment In:
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Ann Intern Med. 1990 Feb 15;112(4):242-4
[PMID:
1967520
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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