Distal splenorenal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding - First stage of a randomized, controlled trial

Gian Paolo Spina, Roberto Santambrogio, Enrico Opocher, Felice Cosentino, Alessandro Zambelli, Giovanni Rubis Passoni, Giovanni Cucchiaro, Massimo Macrì, Elisabetta Morandi, Savino Bruno, Giuseppe Pezzuoli

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)178-186
Number of pages9
JournalAnnals of Surgery
Volume211
Issue number2
DOIs
StatePublished - Jan 1 1990
Externally publishedYes

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Surgical Splenorenal Shunt
Sclerotherapy
Randomized Controlled Trials
Hemorrhage
Chronic Brain Damage
Esophageal Stenosis

ASJC Scopus subject areas

  • Surgery

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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 journalArticle

Spina, GP, Santambrogio, R, Opocher, E, Cosentino, F, Zambelli, A, Passoni, GR, Cucchiaro, G, Macrì, M, Morandi, E, Bruno, S & Pezzuoli, G 1990, 'Distal splenorenal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding - First stage of a randomized, controlled trial', Annals of Surgery, vol. 211, no. 2, pp. 178-186. https://doi.org/10.1097/00000658-199002000-00010
Spina, Gian Paolo ; Santambrogio, Roberto ; Opocher, Enrico ; Cosentino, Felice ; Zambelli, Alessandro ; Passoni, Giovanni Rubis ; Cucchiaro, Giovanni ; Macrì, Massimo ; Morandi, Elisabetta ; Bruno, Savino ; Pezzuoli, Giuseppe. / Distal splenorenal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding - First stage of a randomized, controlled trial. In: Annals of Surgery. 1990 ; Vol. 211, No. 2. pp. 178-186.
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