SCLEROTHERAPY IN NONCIRRHOTIC PORTAL FIBROSIS

Endoscopic sclerotherapy has emerged as an effective and safe mode of treatment for long-term management of esophageal varices due to cirrho sis of liver and extrahepatic portal venous obstruction. There are few studies that have evaluated the role of sclerotherapy in the manageme nt of esophageal varices in patients with noncirrhotic portal fibrosis (NCPF). We report our results of long-term sclerotherapy in patients with NCPF. Seventy-two consecutive patients (men 29, women 43; age 32. 9 +/- 11.8 years) with recurrent variceal bleeding due to NCPF were en tered into the sclerotherapy program. Forty-eight patients received in travariceal absolute alcohol and 24 patients received intravariceal so dium tetradecyl sulfate (STD). Variceal obliteration was achieved in 6 5 (90.3%) patients with a mean of 5.7 +/- 3.0 (range 1-14) sessions. T hese patients were followed-up for a mean of 21.4 +/- 20.4 (range 1-96 ) months. Thirteen (17.3%) patients had episodes of upper gastrointest inal bleeding during sclerotherapy. Rebleed after obliteration was see n in 6 (9.2%) patients. Sclerotherapy was associated with a significan t reduction in bleeding rate (bleeds per month per patient) during scl erotherapy and after obliteration of varices as compared to presclerot herapy period (P < 0.000001 for both). Recurrence of esophageal varice s after obliteration was seen in 9 (13.9%) patients with reobliteratio n of varices in five patients in whom sclerotherapy was attempted. Com plications including esophageal ulcer and stricture formation were see n in 18 (25%) and 4 (5.6%) patients respectively; strictures were rest ricted to patients who received absolute alcohol. Two (2.77%) patients died of massive upper gastrointestinal bleed during follow-up. We con clude that sclerotherapy is an effective and safe modality in the prev ention of variceal bleeds in patients with NCPF.