ABSTRACT
One hundred and forty-one patients (100 males, mean age 56.8 +/- 11 years) with a previous bleeding episode from ruptured esophageal varices were followed prospectively after obliteration of varices by elective endoscopic sclerotherapy. Eighty two p. 100 had alcoholic cirrhosis, 30 p. 100 were Child Pugh class A, 60 p. 100 B, 10 p. 100 C. Median follow up period was 16 months. Endoscopic control was carried out on a three month schedule. Compliance was perfect in 81 p. 100 of cases. Recurrent varices developed in 58 patients within a mean (+/- SD) delay of 6.8 +/- 4.7 months. One to 2 sclerotherapy sessions were required to obliterate recurrent varices without serious complications. The frequency of variceal recurrence was significantly lower (p less than 0.001) in case of alcohol with arawal. Five patients (3.5 p. 100) presented a recurrence of variceal bleeding which was fatal in 3 cases. During the follow up period, there were 25 deaths (17.7 p. 100). Survival was significantly correlated to the Child Pugh class (p less than 0.02) and significantly increased in the group of patients who adhered to the protocol (p greater than 0.05). These results suggest that after obliteration of varices patients should be submitted to a trimestrial endoscopic control during the first year, the subsequent schedule being determined by the recurrence of varices during the first year. Endoscopic and clinical follow up of patients, which facilitates alcohol with arawal, could have a favorable effect on the course of hepatic disease.