Criteria for the endoscopic assessment of hemorrhage risk in esophageal varices
Forlini, A.; Gentileschi, P.; Germani, P.P.; Paganelli, C.; Russo, F.; Nasrollah, N.
Il Giornale di Chirurgia 14(9): 504-509
1993
ISSN/ISBN: 0391-9005 PMID: 8167085 Document Number: 419611
The natural history of liver cirrhosis shows one third of patients bleeding from esophageal varices. The first episode of bleeding has a 40% mortality rate and 70% of survivors will have another haemorrhage within a year. To overcome this dramatic sequence the following types of prophylactic treatment have been attempted: portocaval shunt, B-blockers, endoscopic sclerotherapy. Medical Literature shows no proven benefits from these procedures. Endoscopic sclerotherapy seems to have the best results. Thus, to be more successful we suggest a better selection of patients to undergo prophylactic sclerotherapy, also improving the prognostic criteria which could predict the bleeding. Esophagoscopy makes it possible to examine some of the predictive signs of impending haemorrhage. However, both the endoscopic and clinical criteria (Child) give a better evaluation of the risk of bleeding.