Shunt surgery versus endoscopic sclerotherapy for long-term treatment of variceal bleeding. Early results of a randomized trial

L. F. Rikkers, D. A. Burnett, Gary D Volentine, K. N. Buchi, R. A. Cormier

Research output: Contribution to journalArticle

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Abstract

In September 1982, a prospective randomized trial comparing shunt surgery and endoscopic sclerotherapy for the elective management of variceal hemorrhage in patients with cirrhosis was initiated. Twenty-seven patients have received shunt (distal splenorenal = 23, nonselective = 4) and 30 patients have had chronic sclerotherapy. Eighty-six per cent of patients had alcoholic cirrhosis and 33% were Child's class C. After a mean follow-up of 25 months, 19% of shunt and 57% of sclerotherapy patients have had rebleeding (p = 0.003). Kaplan-Meier survival analysis reveals similar 2-year survival rates for shunt (65%) and sclerotherapy (61%) groups. Only two of 10 sclerotherapy failures have been salvaged by surgery. Posttherapy quantitative hepatic function, frequency of encephalopathy, and cumulative medical costs were similar for both groups. Hepatic portal perfusion and portal pressure at 1 year were better maintained by sclerotherapy than by distal splenorenal shunt. In conclusion, endoscopic sclerotherapy and shunt surgery provide similar results with respect to survival, hepatic function, frequency of encephalopathy, and costs. Sclerotherapy is an acceptable, but not superior, alternative to shunt surgery for treatment of variceal hemorrhage.

Original languageEnglish (US)
Pages (from-to)261-271
Number of pages11
JournalAnnals of surgery
Volume206
Issue number3
DOIs
StatePublished - Jan 1 1987

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Sclerotherapy
Hemorrhage
Surgical Splenorenal Shunt
Brain Diseases
Therapeutics
Liver
Portal Pressure
Costs and Cost Analysis
Alcoholic Liver Cirrhosis
Kaplan-Meier Estimate
Survival Analysis
Fibrosis
Survival Rate
Perfusion
Survival

ASJC Scopus subject areas

  • Surgery

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Shunt surgery versus endoscopic sclerotherapy for long-term treatment of variceal bleeding. Early results of a randomized trial. / Rikkers, L. F.; Burnett, D. A.; Volentine, Gary D; Buchi, K. N.; Cormier, R. A.

In: Annals of surgery, Vol. 206, No. 3, 01.01.1987, p. 261-271.

Research output: Contribution to journalArticle

Rikkers, L. F. ; Burnett, D. A. ; Volentine, Gary D ; Buchi, K. N. ; Cormier, R. A. / Shunt surgery versus endoscopic sclerotherapy for long-term treatment of variceal bleeding. Early results of a randomized trial. In: Annals of surgery. 1987 ; Vol. 206, No. 3. pp. 261-271.
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