Prognostic indicators of successful endoscopic sclerotherapy for prevention of rebleeding from oesaphageal varices in cirrhosis: a long-term cohort study

Background, Although band ligation is now recommended for prevention of reb leeding from oesophageal varices in cirrhosis, sclerotherapy is still widel y used. Patients submitted to chronic sclerotherapy undergo several endosco pies and experience a large number of serious complications. However long-t erm outcome Is poorly defined. Aims, To assess the clinical course and prognostic indicators of patients u ndergoing chronic sclerotherapy for prevention of variceal rebleed as a bas is for future evaluation of long-term band ligation outcome. Methods, Prospective cohort study prognostic analysis by the Cox proportion al hazards model. Results. A total of 218 consecutive cirrhotic patients (37 Child class A, 1 54 B, 27 C) were enrolled in the study. Varices were obliterated in 139 (64 %) patients in a mean of 5 (+/-2.6) sessions and recurred in 58/139 (41.7 % ) within one year. A total of 139 (60%) patients experienced 283 rebleeding episodes and 73 (33%) died. Bleeding from oesophageal ulcers was the most serious complication causing 14% of all rebleeding episodes. Significant pr ognostic indicators of sclerotherapy outcome were: Child-Pugh class for var iceal obliteration; gastric varices and platelet count for recurrence of va rices; failure to obliterate varices, variceal size and gastric varices for rebleeding; blood urea nitrogen and failure to obliterate varices for deat h. Presence of gastric varices was the only prognostic indicator for death in the 79 patients not achieving variceal obliteration. A mean of 10 endosc opies and of 6 hospital admissions were needed per each patient with an est imated cost of US$ 7154 per patient during the first two years of therapy. Conclusions, Sclerotherapy is a very demanding and costly treatment, and is associated with fi frequent and serious side-effects. The probability of t reatment failure is significantly higher in Child C patients with gastric v arices. Alternative treatments should be considered for these patients.