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This paper reports the preliminary results of a prospective randomized trial comparing endoscopic variceal sclerosis and distal splenorenal shunt (DSRS) in the management of patients with cirrhosis and variceal bleeding. Seventy-one patients have been entered; 36 have received sclerosis and 35 DSRS. Randomization of the study population was stratified on Child's A/B (56%) and Child's C (44%). Sixty-one per cent had alcoholic and 39% non-alcoholic cirrhosis. No patients have been lost to follow-up, which currently stands at a median of 26 months. Rebleeding occurred significantly (p less than 0.05) more frequently in patients in the sclerosis group (19 of 36: 53%) compared to DSRS (1 of 35: 3%), but only 11 of 36 (31%) were not controlled by further sclerosis and failed that therapy. Patients in whom sclerosis failed underwent surgery. Survival was significantly (p less than 0.01) improved in the sclerosis group (+ surgery in 31%), with an 84% 2-year survival compared to a 59% 2-year survival in the DSRS group. Portal perfusion was significantly (p less than 0.05) better maintained in the sclerosis (95%) compared to the DSRS (53%) group. Galactose elimination capacity improved significantly (p less than 0.05) in 21 patients successfully managed by sclerosis at 1 year and was significantly (p less than 0.01) better maintained in the sclerosis compared to DSRS group. The authors conclude that endoscopic sclerosis: has a higher rebleeding rate than DSRS, with one third of patients failing therapy from rebleeding; allows significant improvement in liver function when successful; and gives significantly improved survival in the management of variceal bleeding when backed up by surgical therapy for patients with uncontrolled rebleeding.
W D Warren, and
J M Henderson, and
W J Millikan, and
J T Galambos, and
W S Brooks, and
S P Riepe, and
A A Salam, and
M H Kutner
January 1994,
World journal of surgery,
W D Warren, and
J M Henderson, and
W J Millikan, and
J T Galambos, and
W S Brooks, and
S P Riepe, and
A A Salam, and
M H Kutner
May 2006,
Gastroenterology,
W D Warren, and
J M Henderson, and
W J Millikan, and
J T Galambos, and
W S Brooks, and
S P Riepe, and
A A Salam, and
M H Kutner
September 1988,
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W D Warren, and
J M Henderson, and
W J Millikan, and
J T Galambos, and
W S Brooks, and
S P Riepe, and
A A Salam, and
M H Kutner
September 1987,
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W D Warren, and
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M H Kutner
February 1990,
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W D Warren, and
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May 1997,
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W D Warren, and
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S P Riepe, and
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M H Kutner
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Hepatology (Baltimore, Md.),
W D Warren, and
J M Henderson, and
W J Millikan, and
J T Galambos, and
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M H Kutner
January 1993,
American journal of surgery,
W D Warren, and
J M Henderson, and
W J Millikan, and
J T Galambos, and
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S P Riepe, and
A A Salam, and
M H Kutner
April 1987,
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W D Warren, and
J M Henderson, and
W J Millikan, and
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M H Kutner
June 1997,
The American journal of gastroenterology,
