Emergency sclerotherapy for control of acute oesophageal variceal bleeding using 3% aqueous phenol: a 15-year experience.

BACKGROUND

The purpose of the present study was to compare the efficacy of emergency endoscopic variceal sclerotherapy (EVS) using 3% aqueous phenol as an initial procedure to control acute oesophageal variceal bleed.

METHODS

One hundred and ninety-five consecutive patients presenting with acute variceal bleed were included in the study. Protocol based endoscopic sclerotherapy and management of bleeding oesophageal varices was done. Immediate cessation of bleeding, re-bleeding within the first 72 h, success of first injection, final success of EVS, short-term mortality, influence of aetiology of portal hypertension and severity of liver disease on these results were studied.

RESULTS

Immediate cessation of bleeding was obtained in 191 out of 195 patients (97.9%). Twenty-seven (13.8%) patients re-bled within 72 h. On re-injection final success of EVS was 87.2% (170/195 patients). There was no significant difference between final success rate in cirrhotic versus non-cirrhotic patients (103/118 (87.3%) vs. 67/77 (87%)). Success of first sclerotherapy session was significantly higher than that of second sclerotherapy session. Surgical rescue was required in 25 (12.8%) patients. Mortality was 3.6%. Failure of EVS and mortality was significantly higher in Child's C group (P = 0.04, Relative risk = 0.5, confidence interval 0.22-1.16).

CONCLUSION

EVS remains an effective and cost effective modality of treatment to control acute variceal bleeding irrespective of aetiology of portal hypertension provided strict protocol based management is followed. With timely surgical rescue for the failures, the overall mortality can be reduced to less than 5%.