ENDOSCOPIC SCLEROTHERAPY OF BLEEDING ESOPHAGEAL-VARICES - A COMPARATIVE-STUDY OF RESULTS IN PATIENTS WITH SCHISTOSOMIASIS AND CIRRHOSIS

Endoscopic sclerotherapy for bleeding esophageal varices was carried out in 78 patients with schistosomiasis (Group I) and 71 cirrhotic patients (Group II). All group I patients had uniformly good liver function. According to Child''s classification 25 patients (35%) of Group II were Child A, 16 (23%) Child B and 30 (42%) Child C. The sclerotherapy was performed by intravascular injections of 3% ethanolamine. Throughout a follow-up period of at least 24 months, hemorrhage recurred in 13% of the Group I patients, with one death (1%). The Child A category had a 24% recurrence with a 4% death rate, Child B a 38% recurrence with a 50% death rate, and Child C group A 73% recurrence with no survivors. A comparison of patients with schistosomiasis and cirrhosis type A revealed no differences with respect to rebleeding or survival (P > 0.05). Differences were significant for bleeding recurrence and survival in Child B patients as compared with schistosomiasis patients (p < 0.025). This difference was highly remarkable when patients with schistosomiasis were compared with Child C cases, both for recurrence and survival (p < 0.001). On the basis of these observations it is concluded that results of sclerotherapy depend fundamentally on liver function, and thus this procedure is justified in the early phases of liver cirrhosis.