A Prospective study of Esophageal Variceal Recurrence and Rebleed Rates after Primary Eradication

Selva Sekaran, R (2008) A Prospective study of Esophageal Variceal Recurrence and Rebleed Rates after Primary Eradication. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION : Bleeding from esophageal varices is the leading cause of death in patients with portal hypertension, with a mortality of up to 50% for the initial bleed and 30% for subsequent bleeds. Endoscopic variceal sclerotherapy (EST) has been widely used in the emergency treatment of patients with actively bleeding esophageal varices . Even though the initial bleed may effectively be controlled by sclerotherapy, the risk of subsequent rebleeding is substantial. There is a general consensus that patients surviving a bleed episode should be treated to prevent rebleeding. Considerable evidence has supported the use of repeated sclerotherapy to obliterate esophageal varices to prevent further variceal bleeding . While undergoing sclerotherapy before eradication, patients may continue to have variceal bleeds. Repeated injection also increases the cumulative risk of developing complications in patients . Endoscopic variceal ligation (EVL), is widely used, may provide safer and quicker eradication of varices . However, no long-term data for recurrent bleeding after variceal eradication by ligation exists and there is a concern that rebleeds may be higher after ligation than after sclerotherapy. The cost and affordability by the patient has resulted in selective use of EVL when compared to EST which is cheaper and readily available in all centers in the Indian subcontinent. Also a recent study from the our Institution has highlighted the natural history of oesophageal varices in an era of sclerotherapy. The rebleed rate was 29.4 %. Despite the previous widespread use of endoscopic sclerotherapy, accurate data on long-term recurrence and rebleeding after variceal eradication and the need and optimal frequency of endoscopic surveillance are scant. Eradication of esophageal varices by repeated injection sclerotherapy and maintenance of eradication using continued surveillance endoscopy may reduce recurrent variceal bleeding and death from esophageal varices. AIM : This present study aimed to evaluate prospectively the overall long-term clinical outcome in terms of recurrence of varices and rebleed rates after eradication of varices following EST in consecutively treated cirrhotic patients with bleeding esophageal varices. CONCLUSION : 133 patients with variceal bleed due to cirrhosis with portal hypertension were registered between January 2006 and Dec 2006. • A total of 611 EST sessions were performed with a mean of 4.6 injections for obliteration of varices. • Complications related to injection sclerotherapy were mostly minor. • 78 (58.6%) patients had variceal eradication by after a median of 4.77 injections by April 2007 and were followed up to March 2008. • Varices recurred in 52.6% patients; 78% recurred within 6 months. • Rebleed occurred in 34.1% and in 78.6% instances the bleed occurred within 3 months. • In 37 patients the varices remained eradicated until the end of the study. Bleed related deaths were low after variceal eradication.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Esophageal Variceal Recurrence ; Rebleed Rates ; Primary Eradication ; Prospective study.
Subjects: MEDICAL > Gastroenterology
Depositing User: Kambaraman B
Date Deposited: 13 Jul 2017 04:16
Last Modified: 13 Jul 2017 04:16
URI: http://repository-tnmgrmu.ac.in/id/eprint/1579

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