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  • Title: [Treatment of bleeding oesophageal varices. Results of combined medical and endoscopically selective intravascular sclerotherapy].
    Author: Brunner G, Harke U.
    Journal: Dtsch Med Wochenschr; 1982 Nov 26; 107(47):1791-5. PubMed ID: 6982806.
    Abstract:
    Combining careful medical preparation with subsequent selective intravascular sclerotherapy, one-year survival rate of patients with bleeding oesophageal varices was increased to 90%. Of 41 patients with bleeding oesophageal varices, class Child A-C, none died of bleeding from the varices within the first year after sclerotherapy. Four patients died within the first year, two from liver failure due to severe alcohol abuse, one from liver failure with terminal primary biliary cirrhosis and one from an undiagnosed bleeding duodenal ulcer. Improved results were obtained by two measures: (1) instead of immediate sclerosing at time of diagnosis, initial arrest of bleeding with a Sengstaken tube and, if necessary, administration of vasopressin and improvement in general status by intensive measures to stabilise the circulation and clotting mechanism; (2) selective radiologically controlled intravascular sclerotherapy with a flexible special endoscope 1-2 days after admission. The particular advantage of selective intravascular sclerosing, though it is complicated, lies in the fact that fundal varices and supplying veins to the stomach can also be sclerosed and severe early as well as late complications are exceedingly rare.
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