A comparative study of the elective treatment of variceal hemorrhage with beta-blockers, transendoscopic sclerotherapy, and surgery - A prospective, controlled, and randomized trial during 10 years

Objective To compare three options for the elective treatment of portal hypertension during a 10-year period. Methods Patients included in the trial were 18 to 76 years old, had a history of bl eeding portal hypertension, and had undergone no prior treatment. Treatment options were beta-blockers (propranolol), sclerotherapy, and portal blood flow-preserving procedures (selective shunts and the Sugiura-Futagawa opera tion). Results A total of 119 patients were included: 40 in the pharmacology group, 46 in the sclerotherapy group,and 33 in the surgical group. The three groups show ed no differences in terms of age, Child-Pugh classification, and cause of liver disease. The rebleeding rate was significantly tower in the surgical group than in the other two groups. The rebleeding rate was only 5% in the Child A surgical group, compared with 71% and 68% for the sclerotherapy and pharmacotherapy groups, respectively. Survival was better for the low-risk patients (Child A) in the three groups, but when the three options were co mpared, no significant difference was found. Conclusions Portal blood flow-preserving procedures offer the lowest rebleeding rate in low-risk patients undergoing elective surgery.