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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Long-term management of variceal bleeding: The place of varix injection and ligation
World Journal of Surgery, Volume 18, No. 2, Year 1994
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Description
Injection sclerotherapy remains the most widely used long-term management for patients after an esophageal variceal bleed. Sclerotherapy treatments should be repeated weekly until the varices are eradicated. Follow-up endoscopy every 6 to 12 months is required for life. Whenever varices recur, further weekly injection treatments are administered until re-eradication is achieved. Failure of sclerotherapy must be diagnosed early and an alternative salvage procedure performed. We currently recommend the distal splenorenal shunt. Although the complications of sclerotherapy are not great, they are cumulative with time. Unlike most surgical procedures for portal hypertension, the technique of performing sclerotherapy is not standardized, making the comparison of controlled trials difficult. The current status of controlled trials comparing sclerotherapy with other treatments is evaluated. We conclude that repeated injection sclerotherapy is at present the initial treatment of choice for patients after an esophageal variceal bleed. The technique of the new procedure of esophageal variceal ligation is described. As with sclerotherapy, weekly treatment sessions are recommended until the esophageal varices are eradicated, followed by long-term endoscopic surveillance and repeat ligation treatment when varices recur. The four controlled trials that have compared variceal ligation with sclerotherapy favor ligation. Ligation eradicated esophageal varices with fewer treatment sessions and a lower complication rate. One trial demonstrated improved survival. Complications due to the overtube are being increasingly reported but were not a problem in the controlled trials. Although esophageal variceal ligation or ligation plus sclerotherapy may ultimately prove to be superior to sclerotherapy alone, more data are required before a final conclusion can be reached. © 1994 Société Internationale de Chirurgie.
Authors & Co-Authors
Terblanche, John T.
France, Rennes
University Regional Hospital
South Africa, Observatory
Groote Schuur Hospital
France, Rennes
University of Rennes
South Africa, Cape Town
University of Cape Town
Stiegmann, Gregory Van
United States, Aurora
University of Colorado Anschutz Medical Campus
Krige, Jacobus E.J.
South Africa, Observatory
Groote Schuur Hospital
South Africa, Cape Town
University of Cape Town
Bornman, Philippus C.
South Africa, Observatory
Groote Schuur Hospital
South Africa, Cape Town
University of Cape Town
Statistics
Citations: 18
Authors: 4
Affiliations: 5
Identifiers
Doi:
10.1007/BF00294399
ISSN:
03642313
e-ISSN:
14322323
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study