Injection sclerotherapy versus splenectomy and devascularization for management of active bleeding varices

ABSTRACT

Bleeding Oesophageal varices represent the commonest cause of acute upper gastrointestinal bleeding in Egypt due to the prevalence not only of bilharziasis but also chronic hepatitis. In this study 60 patients with bleeding oesophageal varices were randomly allocated to injection sclerotherapy or to splenectomy and devascularization. The included patients were followed up for one year. In 30 patients treated by injection sclerotherapy as an emergency procedure bleeding was controlled but in 3 patients bleeding persisted. Sengstaken tube tamponade was effective in controlling bleeding in 2 patients and the third one needed urgent splenectomy and devascularization. Recurrent bleeding during the follow up period occurred in 5 cases [16.6%] and 3 patients died [10%]. Among 30 patients treated by splenectomy and devascularization, 12 patients underwent emergency surgery which was adequate for bleeding control except in one patient which needed in addition injection sclerotherapy following the operation. Elective splenectomy and devascularization was done for the remaining 18 patients after successful bleeding control by the conservative measures including Sengstaken tube tamponade. Recurrent bleeding occurred in 4 patients [13.3%]. Three patients [25%] died when the operation was done as an emergency procedure and another 3 patients [16.6%] died following elective surgery. These results indicate that injection sclerotherapy can be effective in controlling bleeding oesophageal varices but with less complications than splenectomy and devascularization specially when urgently done