RESUMO
Background: The better treatment modalities for bleeding esophageal varices have improved the prognosis of cirrhosis. Aim: To inquire about diagnostic and treatment modalities for esophageal bleeding in Chile. Material and methods: An enquiry about diagnosis and treatment of esophageal bleeding was designed and electronically sent to public and private health institutions that could admit patients and were located in cides with more than 100,000 inhabitants. Results: The enquiry was answered by 31 of 35 public and 17 of 19 private health institutionis that were consulted. Emergency endoscopy was available in 6 of 27 public and in the 16 private institutionis that had an emergency room. Rubber band ligation was available in 16 public (52 percent) and in all private institutions. Cyanoacrylate injections were done in 10 public (32 percent) and 11 (65 percent) private institutions. No public institution installed transjugular intrahepatic portosystemic shunts, but 8 had occasional access to this technique. This procedure was done in 7 (41 percent) private institutions and all had access to it. Surgical treatment was feasible in 20 public (65 percent) and all private institutions. Primary prophylaxis was done in 18 public (58 percent) and 14 private (82 percent) institutions. Secondary prophylaxis was carried out in 26 public (84 percent) and 16 private (94 percent) institutions. Conclusions: Public health institutions have poor access to adequate diagnostic and treatment methods for esophageal bleeding. The primary and secondary prophylaxis of esophageal varices must be improved in both types of institutions.
Assuntos
Humanos , Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/terapia , Serviços de Saúde/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Chile , Cianoacrilatos/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Varizes Esofágicas e Gástricas/prevenção & controle , Pesquisas sobre Atenção à Saúde , Hospitalização/estatística & dados numéricos , Hospitais Privados/normas , Hospitais Públicos/normas , RecidivaRESUMO
Entre agosto de 1988 y diciembre de 1992 se realizó un programa de escleroterapia en 9 niños que habían sangrado por várices esofágicas. La enfermedad base era cavernomatosis de la porta en cinco y daño hepático crónico en los otros. Cinco de los pacientes habían sido tratados previamente en relación con sus hemorragias en otros centros. Tres niños que sangraban activamente fueron tratados mediante inyección intravaricosa de cianoacrilato, con resultados positivos. La erradicación de las várices se consiguió en los nueve niños inyectando polidocanol 1% endo y paravaricoso en sesiones semanales. Ninguno de estos pacientes volvió a sangrar a partir de várices esofágicas durante la fase de erradicación, aunque uno lo hizo por várices subcardiales. En este caso la hemorragia fue detenida mediante mediante desvascularización gástrica. No se observaron complicaciones atribuibles al procedimiento durante la fase de erradicación. Los pacientes fueron controlados, en promedio, 19 meses (márgenes 3 y 52 meses), durante los cuales no se registraron sangramientos recidivantes y estenosis esofágicas. La escleroterapia de várices esofágicas parece una buena opción terapéutica en niños portadores de hipertensión portal sintomática