ENDOSCOPIC INJECTION SCLEROTHERAPY FOR ESOPHAGEAL-VARICES IN THE ELDERLY

A group of 1127 patients who underwent sclerotherapy for esophageal va rices were compared for outcome in terms of age: over and under age 70 years. Esophageal varices were completely eradicated in 81 of 110 pat ients >70 years (73.6%) and in 791 of 1017 patients <70 years (77.8%). Gastrointestinal bleeding after sclerotherapy occurred in 9 patients >70 years (8.2%) and in 84 of those <70 years (8.3%). Complications oc curred in 16 patients >70 gears (14.5%) and in 141 <70 years (13.9%). Liver failure and hepatoma accounted for more than 80% of the causes o f death in both groups (80.3% versus 83.8%). The 9-year cumulative sur vival rates in patients with bleeding esophageal varices (bleeders) wi thout hepatoma were 21.8% in those >70 years and 58.7% in those <70 ye ars (p < 0.01), the relative survivals being 25.3% versus 66.6%. Patie nts without hepatoma and treated by prophylactic sclerotherapy account ed for 66.2% of patients >70 years and 61.7% of those <70 years, the r elative survivals being 75.9% versus 71.9%. As analyzed by the Cox pro portional-hazards model, age >70 years was a prognostic factor in the bleeders (p < 0.01) but not in the nonbleeders. We recommend that elde rly patients with esophageal varices be given prophylactic sclerothera py, as the outcome for these patients is poor once bleeding has occurr ed.