MESOCAVAL SHUNT OR REPEATED SCLEROTHERAPY - EFFECTS ON REBLEEDING ANDENCEPHALOPATHY - A RANDOMIZED TRIAL

Background. Sclerotherapy is usually effective in controlling acutely bleeding esophageal varices. It may nob be as effective as shunt surge ry for prevention of rebleeding; therefore we undertook a prospective study comparing interposition mesocaval shunt (MCS) and repeated scler otherapy. Methods. Forty-five patients (mean age, 52.6 +/- 9.8 years) with variceal bleeding were randomized after emergency endoscopic scle rotherapy either to repeat variceal obliteration followed by regular c heck endoscopy (n = 21) or to elective interposition mesocaval shuntin g 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 t otal shunting I year after MCS. The median hospital stay teas 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 n oted in survival in patients with Child's A and Child's B disease in t he treatment groups. In patients with Child's C cirrhosis there was a statistically significant longer survival in patients underoing MCS co mpared with patients undergoing sclerotherapy. Conclusions. The result s of the study show that the rate of rebleeding is significantly highe r after sclerotherapy than after mesocaval shunting. In patients with Child's C cirrhosis n ICS mall be an alternative to sclerotherapy for the prevention of rebleeding from esophageal varices in patients not s uitable Jar transplantation.