TREATMENT OF BLEEDING ESOPHAGEAL-VARICES WITH CYANOACRYLATE AND POLIDOCANOL, OR POLIDOCANOL ALONE - RESULTS OF A PROSPECTIVE-STUDY IN AN UNSELECTED GROUP OF PATIENTS WITH CIRRHOSIS OF THE LIVER

Background and Study Aims: Data concerning the results with emergency and further elective therapy of esophageal varices using polidocanol a nd cyanoacrylate, or polidocanol alone, in an unselected group of pati ents with liver cirrhosis have not previously been available. The aim of the present prospective study was to evaluate acute and repeated cy anoacrylate and polidocanol therapy in the emergency and long-term ele ctive management of esophageal varices. Methods: In accordance with th e protocol of the present prospective study, acutely bleeding esophage al varices of grades 1 to 3 were treated endoscopically with polidocan ol injection, while grade 4 varices, large solitary varices (over 5 mm ) and otherwise uncontrollable cases of variceal bleeding were treated by injection of cyanoacrylate and polidocanol. Over a period of 62 mo nths, 112 patients (65 men, 47 women) with acute bleeding from esophag eal varices due to cirrhosis of the liver (69% alcohol-related) underw ent a total of 245 treatment sessions in hospital. The average age of the patients was 62.0 +/- 12.3 years (58.1% were 60 or older). Hepatic function corresponded to Child-Pugh class A in 38 patients (33.9%), C hild-Pugh class B in 68 patients (60.7%), and Child-Pugh class C in si x (4.5%). Results: Sixty-eight patients (60.7%) were treated with poli docanol alone, and 44 (39.3%) with cyanoacrylate and polidocanol. Acut e hemostasis was achieved in all cases. In 5.7% of the sclerotherapy p rocedures, bleeding ulcers were observed, and a pleural effusion was s een in one case. The hospital mortality rate was 24.1%, resulting from the bleeding in 2.7% and due to liver failure in the remaining cases. Recurrent bleeding occurred within 24 hours in four patients (3.6%), and during the later course of the hospital stay in a further 11 patie nts (9.8%). The mean survival time was 13.7 +/- 17.7 months. Over the entire observation period of 23 +/- 21 months, 67 patients died (59.8% ); the cause of death was hemorrhage in 4.5%, the underlying hepatic d isease in 65.7%, and non-hepatic causes in 29.8%. Recurrent bleeding o ccurred in 58 patients (51.7%). The cumulative survival rate in the pa tients treated with cyanoacrylate and polidocanol was 66 +/- 15% and 2 6 +/- 32% after one and five years, respectively, and 56 +/- 13% and 3 3 +/- 19% in those treated with polidocanol alone. Conclusions: Endosc opic treatment of esophageal varices with cyanoacrylate and polidocano l, or polidocanol alone, is effective in controlling bleeding, and the complication rate is tolerable. The short-term and longterm mortality rates are determined largely by the underlying liver disease.