Risk factors determining the outcome of injection sclerotherapy

ABSTRACT

A total of 100 patients with bleeding oesophageal varices were treated with injection sclertotherapy. The success rate in the initial control of bleeding, the complications of sclerotherapy and the risk affecting the prognosis of the patients as regards the recurrence of bleeding succeeded in 90% of the cases. The chance of success is less in patients with bad liver function, those with previous attacks of bleeding and the patient with grades III and IV oesophageal varices. Thirteen patients died in hospital in the first postsclerotherapy week. Of the deaths were due to failure of initial control of bleeding. Considering the complications of sclerotherapy apart from deaths due to bleeding from postsclertherapy ulcerations all the other complications were not fatal and included mild pyrexia, chest pain, dysphagia and postobliteration gastric varices. Patients with bad liver function, shrunken liver and previous attacks of bleeding had a higher risk of rebreeding. Patients with bad liver function, previous attacks of bleeding and high grade oesophageal varices also had a higher death rate. It was noticed that most of the deaths in the first 3 months after injection sclerotherapy were due to recurrence of bleeding andthis is the period when the varices are still large and need further injection for obliteration. So we recommend the use of strict carful injection for patients who are at a high risk of rebreeding together with correction of any haemostatic defects and amelioration of ascites if present. Continuation of injection sclerotherpy till complete obliteration of the varices is a must in all cases particularly the high risk group