Results of sclerotherapy for bleeding esophageal varices in patients with schistosomal liver disease. A retrospective study

Background/aims: The aims of the study were to evaluate results of injectio n sclerotherapy in patients with liver schistosomiasis inducing bleeding es ophageal varices and to review ultrasonographic features of the liver disea se as well as endoscopic characteristics of the esophageal disease in order to assess any interrelationship between them. Methodology: A total of 34 patients with active or recent history of hemate mesis and Schistosoma mansoni infection had emergency or elective endoscopi c sclerotherapy. Each underwent ultrasound examination to assess hepatosple nic involvement and staging, and were followed-up with upper digestive endo scopy every 4 months. Results: Obliteration or reduction of the varices in small columns was achi eved in 82.3% of cases. During the follow-up period (mean:10.4+/-2.1 months; range: 4-16 months) re bleeding was noted in 2 patients and 2 patients died due to variceal hemorr hage. The relationship between the ultrasonographic periportal fibrosis grade and the endoscopic variceal grade or varices localization was very strong (P<0 .001). A significant difference between grade 1 vs. 3 and 1 vs. 2 of periportal fi brosis and the presence of red signs was also found (P<0.008). Conclusions: In view of the results obtained in terms of success rate in ob literating varices, rebleeding and mortality rates, a longitudinal study co uld be justified to assess the usefulness of prophylactic sclerotherapy for the prevention of the first variceal hemorrhage and in the attempt to prol ong survival in patients with Schistosoma-induced esophageal varices.