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South African Journal of Surgery

versão On-line ISSN 2078-5151
versão impressa ISSN 0038-2361

S. Afr. j. surg. vol.47 no.3 Cape Town Ago. 2009




Early rebleeding and death at 6 weeks in alcoholic cirrhotic patients with acute variceal bleeding treated with emergency endoscopic injection sclerotherapy



J. E. J. KrigeI; U. K. KotzeII; J. M. ShawIII; P. C. BornmanIV

IM.B. CH.B., F.A.C.S., F.R.C.S. (ED.), F.C.S. (S.A.), Department of Surgery and MRC Liver Research Centre, University of Cape Town Faculty of Health Sciences and Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town
IIR.N., R.M., C.H.N., B.A. CUR., Department of Surgery, University of Cape Town Faculty of Health Sciences and Surgical Gastroenterology Unit, Groote Schuur Hospital
IIIM.B. B.CH., M.MED. (SURG.), F.C.S. (S.A.), Department of Surgery and MRC Liver Research Centre, University of Cape Town Faculty of Health Sciences and Surgical Gastroenterology Unit, Groote Schuur Hospital
IVM.B. CH.B., M.MED., F.R.C.S. (ED.), F.R.C.S. (GLASG.), F.C.S. (S.A.), Department of Surgery and MRC Liver Research Centre, University of Cape Town Faculty of Health Sciences and Surgical Gastroenterology Unit, Groote Schuur Hospital




BACKGROUND: This study evaluated the incidence of rebleeding and death at 6 weeks after a first episode of acute variceal haemorrhage (AVH) treated by emergency endoscopic sclerotherapy in a large cohort of alcoholic cirrhotic patients.
METHODS: From January 1984 to December 2006, 310 alcoholic cirrhotic patients (242 men, 68 women; mean age 51.7 years) with AVH underwent 786 endoscopic variceal injection treatments (342 emergency, 444 elective) during 919 endoscopy sessions in the first 6 weeks after the first variceal bleed. Endoscopic control of initial bleeding, variceal rebleeding and survival at 6 weeks were recorded.
RESULTS: Endoscopic intervention controlled AVH in 304 of 310 patients (98.1%). Seventy-five patients (24.2%) rebled, 38 (12.3%) within 5 days and 37 (11.9%) within 6 weeks. No patient scored as Child-Pugh A died. Seventy-seven (24.8%) Child-Pugh B and C patients died, 29 (9.3%) within 5 days and 48 (15.4%) between 6 and 42 days. Mortality increased exponentially as the Child-Pugh score increased, reaching 80% when the score exceeded 13.
CONCLUSION: Despite initial control of variceal haemorrhage, 1 in 4 patients (24.2%) rebled within 6 weeks. Survival at 6 weeks was 75.2% and was influenced by the severity of liver failure, with most deaths occurring in Child-Pugh grade C patients.


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