SCLEROTHERAPY IN BLEEDING GASTRIC VARICES OF HEPATIC SCHISTOSOMIASIS

hWe report the results of sclerotherapy in 20 patients with bleeding g astric varices due to hepatic schistosomiasis. In an endemic area, pat ients with hepatic schistosomiasis, and bleeding gastric varices seen on endoscopy to be inferior extension of esophageal varices, were trea ted with emergency endoscopic injection just proximal to the cardia. H emostasis was achieved in 17. Obliteration of varices was achieved in all patients with sclerotherapy, combined with surgery. Thirteen patie nts who had not been operated on in the past and consented to surgery underwent esophagogastric devascularization with splenectomy. Surgery was carried out as an emergency in the three patients who did not resp ond to sclerotherapy and electively in 10 patients after control of bl eeding. After surgery, sclerotherapy was required for remnant varices. One patient with Child-Pugh grade C cirrhosis died of hepatic encepha lopathy after control of the bleed. During a median follow-up of 9 mon ths (range, 1-25 months), recurrence of bleeding in one patient and re current varices in two others were controlled with sclerotherapy. One patient had a fatal hemorrhage at home. We conclude that sclerotherapy effectively controls acutely bleeding type 1 gastric varices. Combine d with esophagogastric devascularization and splenectomy, long-term re sults may be encouraging in patients with hepatic schistosomiasis.