Qq. Contractor et al., SCLEROTHERAPY IN BLEEDING GASTRIC VARICES OF HEPATIC SCHISTOSOMIASIS, Journal of clinical gastroenterology, 23(2), 1996, pp. 97-100
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.