THE LONG-TERM MORBIDITY AND MORTALITY-RATE IN A COHORT OF PATIENTS WITH LIVER-CIRRHOSIS AND ESOPHAGEAL-VARICES

Background/Aims: A long-term study and follow-rep of an uniform treatm ent strategy for esophageal varices was evaluated to plan future strat egies more effectively. Materials and Methods: Morbidity and mortality in 101 patients with liver cirrhosis followed up for 5 years in, a si ngle center after the first detection, of oesophageal varices were stu died. Results: Definitive hemostasis of the first variceal bleeding ep isode could not be obtained in 31.5%, despite emergency endoscopic scl erotherapy in combination with vasopressin and/or balloon tamponade. M ortality related to this bleeding was 26% in this cohort of patients. Overall mortality from variceal bleeding during the 5 year period was 38%. Death occurred predominantly in patients with advanced liver dise ase, since the Child-Pugh score of patients who bled and survived was 8+/-2 as compared to 11+/-2 (p<0.01) in those who bled and died. If fu ndic varices were the origin, of the hemorrhage, the mortality reached 78% within. 6 months. Eighty-five percent of the fatalities were rela ted to the liver disease. Besides variceal bleeding, infection was the predominant trigger Leading to liver failure; occurring in 25%. The c ause of non-liver related death was malignancy of esophagus, lung and pancreas. Only 13% of the patients with Liver failure had undergone an , orthotopic liver transplantation. Conclusion: Since variceal hemorrh age still carries a high mortality rate, primary prophylaxis for patie nts at high fish is indicated. The systematic, concomitant use of vaso active drugs to sclerotherapy and the early performance of TIPS in, ca se of failure of sclerotherapy have to be evaluated. Finally patients with an. advanced liver disease and increased fish factors for varicea l bleeding should be considered earlier for liver transplantation.