Results of sclerotherapy for bleeding esophageal varices in patients with schistosomal liver disease. A retrospective study
Maurizio, R.; Eugenio, C.; Roberto, P.R.
Hepato-Gastroenterology 47(32): 424-428
2000
ISSN/ISBN: 0172-6390 PMID: 10791204 Document Number: 518180
The results of injection sclerotherapy were evaluated in patients with liver schistosomiasis (Schistosoma mansoni) inducing bleeding oesophageal varices. Ultrasonographic features of the liver disease and endoscopic characteristics of the oesophageal disease were reviewed in order to assess any interrelationship between them. 34 patients (20 females, 14 males; mean age 37.3 years) with active or recent history of haematemesis and S. mansoni infection had emergency or elective endoscopic sclerotherapy. Each underwent ultrasound examination to assess hepatosplenic involvement and staging, and were followed-up with upper digestive endoscopy every 4 months. Obliteration or reduction of the varices in small columns was achieved in 82.3% of cases. During the follow-up period (mean: 10.4+or-2.1 months; range: 4-16 months) rebleeding was noted in 2 patients and 2 patients died due to variceal haemorrhage. The relationship between the ultrasonographic periportal fibrosis grade and the endoscopic variceal grade or varices localization was very strong (P<0.001). A significant difference between grade 1 vs. 3 and 1 vs. 2 of periportal fibrosis and the presence of red signs was also found (P<0.008). In view of the results obtained in terms of success rate in obliterating varices, rebleeding and mortality rates, a longitudinal study could be justified to assess the usefulness of prophylactic sclerotherapy for the prevention of the first variceal haemorrhage and in the attempt to prolong survival in patients with Schistosoma-induced oesophageal varices.