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Sclérothérapie prophylactique des varices œsophagiennes à haut risque de saignement etude prospective et randomisée, avec longue période de surveillance

Prophylactic sclerotherapy of esophageal high bleeding risk varices a prospective randomized trial, with a long follow-up

Escleroterapia profiláctica de várices esofágicas de alto riesgo de sangramiento, estudio prospectivo y randomisado con período largo de seguimiento

  • Published:
Acta Endoscopica

Résumé

La présente étude contrôlée, prospective et randomisée, a évalué l’efficacité de la sclérothérapie prophylactique des varices œsophagiennes dans un groupe de patients à haut risque de saignement, mais présentant encore une hémostase conservée avant le premier épisode hémorragique sur varices.

37 patients ont été inclus dans I’étude : 18 ont reçu une sclérothérapie prophylactique, 19 ont servi de cas-témoins. La durée moyenne de surveillance a été de 36,6 mois.

Les taux de mortalité due au saignement au cours de la période complete d’observation ont été significativement inférieurs dans le groupe sclérothérapie par rapport au groupe témoin (P = 0.003)

Les tables de survie montrent que la sclérothérapie prophylactique diminue significativement l’incidence des hémorragies sur varices (P = 0.02) et améliore de façon significative, la survie globale (P = 0.009).

Les auteurs concluent que la sclérothérapie prophylactique est utile dans le traitement des patients cirrhotiques àa haut risque hémorragique avec une fonction hémostatique conservée.

Summary

The efficacy of prophylactic sclerotherapy of varices at high risk of bleeding in cirrhotic patients with spared clotting function before the first episode of variceal haemorrhage, was evaluated in a prospective, randomized, controlled trial.

37 patients were treated as followed : 18 patients received prophylactic sclerotherapy and 19 served as controls. The median follow-up was 36.6 months.

The mortality rate due to bleeding during the overall observation period was significantly lower in the sclerotherapy group versus control group (P = 0.003).

Life table curves showed that prophylactic sclerotherapy significantly diminished the incidence of variceal haemorrhage (P = 0.02) and significantly improved overall survival (P = 0.009).

We concluded that prophylactic sclerotherapy is useful in the treatment of cirrhotic patients with high-risk bleeding varices and spared clotting function.

Resumen

El presente estudio controlado, prospectivo y randomisado, ha evaluado la eficacia de la escleroterapia profiláctica de várices esofágicas en un grupo de pacientes de alto riesgo hemorrágico, pero que — presentan aúm una hemostasis conservada antes del primer episodio — hemorrágico varicoso.

37 pacientes han sido incluídos en el estudio: 18 han recibido una — escleroroterapia profiláctica, 19 han servido de casos testigos. La duración mediana de seguimiento ha sido de 36.6 meses.

La tasa de hemorragia debido al sangramiento en el curso del período completo de observación ha sido significativamente inferior en el grupo de escleroterapia respecto al grupo testigo (P = 0.003).

Las tablas de sobrevida muestran que la escleroterapia profiláctica disminuye significativamente la incidencia de hemorragia sobre várices (P = 0.02) y mejora de manera marcada la sobrevida global (P = 0.009).

Los autores concluyen que la escleroterapia profiláctica es útil en el tratamiento de pacientes cirróticos de alto riesgo hemorrágico con una función de coagulación conservada.

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Authors and Affiliations

  1. I Divisione di Medicina, Servizio di Gastroenterologia, Ospedale civile, Piacenza, Italia

    S. Rossi, F. Fornari, P. Tansini, M. Di stasi, G. Sbolli, E. Buscarini, L. Cavanna, G. Civardi & L. Buscarini

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  1. S. Rossi
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  2. F. Fornari
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  3. P. Tansini
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  4. M. Di stasi
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Additional information

Les résultats préliminaires de cette étude ont été présentés au IIe Meeting NIEC « Hypertension portale et sclérothérapie des varices œsophagiennes », Praglia, Padova, 21-22-23 septembre 1988.

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Rossi, S., Fornari, F., Tansini, P. et al. Sclérothérapie prophylactique des varices œsophagiennes à haut risque de saignement etude prospective et randomisée, avec longue période de surveillance. Acta Endosc 21, 463–472 (1991). https://doi.org/10.1007/BF02970321

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  • DOI: https://doi.org/10.1007/BF02970321

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