ENDOSCOPIC INJECTION SCLEROTHERAPY WITH 1.5-PERCENT SOTRADECOL FOR BLEEDING CARDIAC VARICES

The authors retrospectively studied the efficacy of endoscopic injecti on sclerotherapy (EIS) with 1.5% Sotradecol (STD) in patients with ble eding cardiac varices (CV). Case histories of 27 patients with large, isolated, bleeding CVs were reviewed. Case records of another 27 patie nts with isolated esophageal varices (EV), matched for age, sex, and y ear EIS was performed, were selected from a computer data bank as cont rols. Using a small volume (2-4 ml) of injection per vessel, the rate of immediate control of bleeding was 66.7% (18 of 27) in the CV group and 70.4% (19 of 27) in the EV group. The early rebleeding rate was hi gher for patients in the EV group (48.1%, 13 of 27) than for those in the CV group (18.5%, 5 of 27) (p = 0.0209). On the other hand, it was more difficult to control the rebleeding from CV (p = 0.00494). In ter ms of mortality, there was no statistically significant difference bet ween the CV and EV groups (33.3 Versus 29.6%) within 1 week after EIS, but the 1-month post-EIS mortality rate was significantly higher (p = 0.0278) in the CV group (18 of 27, 66.7%) than in the EV group (10 of 27, 37.0%). Among those in the CV group who died of late complication s within 1 month after EIS, three died of recurrent hemorrhage, five o f infection, and one of viscus perforation. In the EV group, only two patients died of infection. Thus, it was concluded that EIS with small volumes (2-4 ml) of 1.5% STD was equally effective in controlling imm ediate bleeding from CV and EV. However, it was more difficult to cont rol early rebleeding from CV, and the mortality and complications with in 1 month after EIS were significantly higher in patients with CV. Th ese observations are currently under careful study and evaluation.