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Mesocaval shunt or repeated sclerotherapy: effects on rebleeding and encephalopathy--a randomized trial.

Abstract：

BACKGROUND:Sclerotherapy is usually effective in controlling acutely bleeding esophageal varices. It may not be as effective as shunt surgery for prevention of rebleeding; therefore we undertook a prospective study comparing interposition mesocaval shunt (MCS) and repeated sclerotherapy. METHODS:Forty-five patients (mean age, 52.6 +/- 9.8 years) with variceal bleeding were randomized after emergency endoscopic sclerotherapy either to repeat variceal obliteration followed by regular check endoscopy (n = 21) or to elective interposition mesocaval shunting by use of 14 mm polytetrafluoroethylene graft (n = 24). There was an equal distribution of Child's classes in the two groups. RESULTS:In the sclerotherapy group 12 patients had recurrent hemorrhages causing five deaths compared with the shunt group, in which four patients had postoperative bleeding but without associated death. No difference was noted in the incidence of encephalopathy despite the development of total shunting 1 year after MCS. The median hospital stay was similar; 34.5 days (MCS) and 33 days (sclerotherapy). The number of intensive care unit days was also similar in the two groups. No difference was noted in survival in patients with Child's A and Child's B disease in the treatment groups. In patients with Child's C cirrhosis there was a statistically significant longer survival in patients undergoing MCS compared with patients undergoing sclerotherapy. CONCLUSIONS:The results of the study show that the rate of rebleeding is significantly higher after sclerotherapy than after mesocaval shunting. In patients with Child's C cirrhosis MCS may be an alternative to sclerotherapy for the prevention of rebleeding from esophageal varices in patients not suitable for transplantation.

journal_name

Surgery

journal_title

Surgery

authors

Isaksson B,Jeppsson B,Bengtsson F,Hannesson P,Herlin P,Bengmark S

doi

10.1016/s0039-6060(05)80248-x

subject

Has Abstract

pub_date

1995-05-01 00:00:00

pages

498-504

issue

5

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(05)80248-X

journal_volume

117

pub_type

临床试验,杂志文章,随机对照试验

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