Injection sclerotherapy for variceal bleeding in patients with irresectable hepatocellular carcinoma

Background/Aims: Patients with cirrhosis and advanced hepatocellular carcin oma are seldom cured, and have limited survival. Bleeding from esophageal v arices in such patients is a major complication which, if untreated, may be a terminal event. This study evaluated the efficacy of injection Sclerothe rapy in controlling acute bleeding from esophageal varices and the benefit of repeated injection to eradicate varices in patients with cirrhosis and i rresectable hepatocellular carcinoma Methodology: Between 1975 and 1997, nineteen of 688 patients (2.8%) treated for bleeding esophageal varices had cirrhosis and irresectable hepatocellu lar carcinoma. There were 13 men and 6 women; median age, 42 years (range: 20-81). Eight patients were Child's-Pugh grade B and 11 grade C; 11 patient s were Okuda stage II and 8 stage III. Results: In 13 patients (68.4%) bleeding was controlled by injection sclero therapy after a mean of 3 injections (range: 1-5), and of these esophageal varices were completely eradicated in 7 patients (53.9%), none of whom rebl ed. Twelve patients (63%) were discharged from hospital and had a mean surv ival of 100 days. Seven patients died in hospital, 5 of liver failure preci pated by recurrent bleeding and 2 of hepatocellular carcinoma. Median survi val for Child's-Pugh grade B patients was 80 days (range: 9-405) compared t o 28 days (range: 8-117) for the grade C (P=0.25). Conclusions: Injection sclerotherapy controlled acute variceal bleeding in most patients with hepatocellular carcinoma and provided effective palliati ve therapy with no further bleeding after eradication of varices.