ANALYSIS OF LONG-TERM ENDOSCOPIC SURVEILLANCE DURING FOLLOW-UP AFTER VARICEAL SCLEROTHERAPY FROM A 13-YEAR EXPERIENCE

PURPOSE: TO evaluate the course of patients with bleeding esophageal v arices treated with endoscopic sclerotherapy after obliterating varice s and to determine the cost benefits of long-term endoscopic surveilla nce from a retrospective analysis of a 13-year experience. LOCATION: U niversity-affiliated teaching hospital and county facility. METHODS: P atients whose varices were obliterated by endoscopic sclerotherapy wer e considered for the study if they had a minimum of 12 months of follo w-up. Sclerotherapy was initially performed weekly, increasing interva ls to eventual yearly treatments. Varices were reobliterated if they r eformed. Variables assessed were rebleeding, mortality, employment sta tus, and cost based on allowable and reimbursed Medicare rates. RESULT S: Of 324 patients who achieved variceal obliteration, analysis includ ed 104 eligible patients who were followed up for >12 months (41 +/- 2 8). Varices reformed in 73 patients (71%), mostly in the first year af ter obliteration or reobliteration. Abstinent alcoholic patients were least likely to reform varices. Nineteen patients (18%) had 23 rebleed ing episodes, and in 10 patients (10%) portalsystemic shunt was placed . Survival was 84% and bleeding-related mortality was 6%. Significantl y more patients were employed while on the program compared with entry . The yearly cost of treating variceal reformers ($2,117) was signific antly higher than variceal nonreformers ($1,735), but the overall cost of maintaining a patient on a chronic sclerotherapy program was relat ively small. CONCLUSIONS: The low rebleeding, low mortality, and relat ively low cost in patients managed long term by chronic sclerotherapy underscores the benefits of this treatment program. (C) 1997 by Excerp ta Medica, Inc.