ENDOSCOPIC INJECTION SCLEROTHERAPY FOR ESOPHAGEAL-VARICES ASSOCIATED WITH CONCOMITANT PORTAL VENOUS THROMBUS OF HEPATOCELLULAR-CARCINOMA

Between 1983 and 1994, we treated 51 patients with esophageal varices and portal trunk and main branch invasion of hepatocellular carcinoma, using endoscopic injection sclerotherapy. Variceal bleeding was contr olled in 28 of 29 patients (96.6%), esophageal varices were completely eradicated in 28 (54.9%), and only 2 of 28 (7.1%) bled from small, di lated, venous vessels after eradication. The cumulative nonbleeding ra te at 3 years was 87.5%. Death caused by hepatocellular carcinoma acco unted for 89.4% of the patients, whereas the rate of bleeding from eso phageal varices was 4.3%. Variables significantly associated with the duration of survival were Okuda's clinical stage, alpha-fetoprotein, e radication of esophageal varices by sclerotherapy, and treatment of he patocellular carcinoma, as determined in a univariate analysis. Multiv ariate analysis showed that eradication of esophageal varices by scler otherapy, Okuda's clinical stage, and age were independent factors whi ch significantly influenced survival time. We propose that complete er adication of esophageal varices and close follow-up using endoscopy ma y lead to a reduction in bleeding from esophageal varices, and hence m ay reduce mortality rates related to this bleeding. (C) 1995 Wiley-Lis s, Inc.