Abstract
In 1984 we started a prospective controlled trial comparing endoscopic sclerotherapy (ES) with the distal splenorenal shunt (DSRS) in the elective treatment of variceal hemorrhage in cirrhotic patients. The study population included 40 patients with cirrhosis and portal hypertension referred to our department from October 1984 to March 1988. These patients were drawn from a pool of 173 patients who underwent either elective surgery or endoscopic sclerotherapy during this time. Patients were assigned to one of the two groups according to a random-number table: 20 to DSRS and 20 to ES. During the postoperative period, no DSRS patient died, while one ES patient died of uncontrolled hemorrhage. One DSRS patient had mild recurrent variceal hemorrhage despite an angiographically patent DSRS. Four ES patients suffered at least one episode of gastrointestinal bleeding: two from varices and two from esophageal ulcerations. Five ES patients developed transitory dysphagia. Long-term follow-up was complete in all patients. Two-year survival rates for shunt (95%) and ES (90%) groups were similar. One DSRS patient rebled from duodenal ulcer, while three ES patients had recurrent bleeding from esophagogastric sources (two from varices and one from hypertensive gastropathy). One DSRS and two ES patients have evolved a mild chronic encephalopathy, four DSRS and two ES patients suffered at least one episode of acute encephalopathy. Two ES patients had esophageal stenoses, which were successfully dilated. Preliminary data from this trial seem to indicate that DSRS, in a subgroup of patients with good liver function and a correct portal-azygos disconnection, more effectively prevents variceal rebleeding than ES. However no significant difference in the survival of the two treatment groups was noted.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 178-186 |
| Number of pages | 9 |
| Journal | Annals of Surgery |
| Volume | 211 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jan 1 1990 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Surgery
Cite this
Distal splenorenal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding - First stage of a randomized, controlled trial. / Spina, Gian Paolo; Santambrogio, Roberto; Opocher, Enrico; Cosentino, Felice; Zambelli, Alessandro; Passoni, Giovanni Rubis; Cucchiaro, Giovanni; Macrì, Massimo; Morandi, Elisabetta; Bruno, Savino; Pezzuoli, Giuseppe.
In: Annals of Surgery, Vol. 211, No. 2, 01.01.1990, p. 178-186.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Distal splenorenal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding - First stage of a randomized, controlled trial
AU - Spina, Gian Paolo
AU - Santambrogio, Roberto
AU - Opocher, Enrico
AU - Cosentino, Felice
AU - Zambelli, Alessandro
AU - Passoni, Giovanni Rubis
AU - Cucchiaro, Giovanni
AU - Macrì, Massimo
AU - Morandi, Elisabetta
AU - Bruno, Savino
AU - Pezzuoli, Giuseppe
PY - 1990/1/1
Y1 - 1990/1/1
N2 - In 1984 we started a prospective controlled trial comparing endoscopic sclerotherapy (ES) with the distal splenorenal shunt (DSRS) in the elective treatment of variceal hemorrhage in cirrhotic patients. The study population included 40 patients with cirrhosis and portal hypertension referred to our department from October 1984 to March 1988. These patients were drawn from a pool of 173 patients who underwent either elective surgery or endoscopic sclerotherapy during this time. Patients were assigned to one of the two groups according to a random-number table: 20 to DSRS and 20 to ES. During the postoperative period, no DSRS patient died, while one ES patient died of uncontrolled hemorrhage. One DSRS patient had mild recurrent variceal hemorrhage despite an angiographically patent DSRS. Four ES patients suffered at least one episode of gastrointestinal bleeding: two from varices and two from esophageal ulcerations. Five ES patients developed transitory dysphagia. Long-term follow-up was complete in all patients. Two-year survival rates for shunt (95%) and ES (90%) groups were similar. One DSRS patient rebled from duodenal ulcer, while three ES patients had recurrent bleeding from esophagogastric sources (two from varices and one from hypertensive gastropathy). One DSRS and two ES patients have evolved a mild chronic encephalopathy, four DSRS and two ES patients suffered at least one episode of acute encephalopathy. Two ES patients had esophageal stenoses, which were successfully dilated. Preliminary data from this trial seem to indicate that DSRS, in a subgroup of patients with good liver function and a correct portal-azygos disconnection, more effectively prevents variceal rebleeding than ES. However no significant difference in the survival of the two treatment groups was noted.
AB - In 1984 we started a prospective controlled trial comparing endoscopic sclerotherapy (ES) with the distal splenorenal shunt (DSRS) in the elective treatment of variceal hemorrhage in cirrhotic patients. The study population included 40 patients with cirrhosis and portal hypertension referred to our department from October 1984 to March 1988. These patients were drawn from a pool of 173 patients who underwent either elective surgery or endoscopic sclerotherapy during this time. Patients were assigned to one of the two groups according to a random-number table: 20 to DSRS and 20 to ES. During the postoperative period, no DSRS patient died, while one ES patient died of uncontrolled hemorrhage. One DSRS patient had mild recurrent variceal hemorrhage despite an angiographically patent DSRS. Four ES patients suffered at least one episode of gastrointestinal bleeding: two from varices and two from esophageal ulcerations. Five ES patients developed transitory dysphagia. Long-term follow-up was complete in all patients. Two-year survival rates for shunt (95%) and ES (90%) groups were similar. One DSRS patient rebled from duodenal ulcer, while three ES patients had recurrent bleeding from esophagogastric sources (two from varices and one from hypertensive gastropathy). One DSRS and two ES patients have evolved a mild chronic encephalopathy, four DSRS and two ES patients suffered at least one episode of acute encephalopathy. Two ES patients had esophageal stenoses, which were successfully dilated. Preliminary data from this trial seem to indicate that DSRS, in a subgroup of patients with good liver function and a correct portal-azygos disconnection, more effectively prevents variceal rebleeding than ES. However no significant difference in the survival of the two treatment groups was noted.
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UR - http://www.scopus.com/inward/citedby.url?scp=0025097979&partnerID=8YFLogxK
U2 - 10.1097/00000658-199002000-00010
DO - 10.1097/00000658-199002000-00010
M3 - Article
C2 - 2405792
AN - SCOPUS:0025097979
VL - 211
SP - 178
EP - 186
JO - Annals of Surgery
JF - Annals of Surgery
SN - 0003-4932
IS - 2
ER -