Endoscopic sclerotherapy for bleeding oesophagogastric varices secondary to extrahepatic portal vein obstruction in an adult Caucasian population

Background The efficacy of endoscopic sclerotherapy for bleeding oesophagogastric varices secondary to extrahepatic portal vein obstruction in adult Caucasian patients is poorly documented. Objective To assess the results of endoscopic sclerotherapy for all patients with this condition who have been treated and followed in our hospital since 1982. Design Prospective cohort study. Results Twenty-one consecutive patients were included and followed during a mean period of 79 months (range 6-162 months). Active bleeding, encountered in five patients, was controlled by sclerotherapy in all cases. Two patients received a porto-systemic shunt after initial sclerotherapy. In all but one of the remaining 19 cases sclerotherapy resulted in eradication of the varices. The mean bleeding risk after initiation of sclerotherapy was 0.02 bleed/month/patient, which was lower than the estimated 0.13 bleed/month/patient prior to sclerotherapy. The actuarial rate of rebleeding at 5 years due to all causes and due to oesophagogastric varices was 35 and 28%, respectively. Two patients died, both from a haematological (pre-) malignancy. Actuarial 5 year survival was 95%. Conclusion The results of this study are in agreement with findings for paediatric and Asian patient populations and support sclerotherapy as the primary treatment modality for oesophagogastric variceal bleeding in adult Western patients with portal vein thrombosis. Life expectancy for patients with this condition is determined by the underlying cause of the portal venous obstruction.