Natural history of bleeding after esophageal variceal eradication in patients with extrahepatic portal venous obstruction; a 20-year follow-up.
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Date
2009-11
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Abstract
Background Long-term follow-up studies of patients with extrahepatic portal venous obstruction (EHPVO) after eradication
of esophageal varices using endoscopic sclerotherapy
(EST) are limited.
Methods Between 1985 and 1994, 223 patients with bleeding
esophageal varices due to EHPVO underwent variceal eradication
using EST. Regular annual clinical and endoscopic
follow-up data were available for 198 of these patients for a
mean period of 19.8 (range: 14–23) years. These data were
analyzed retrospectively.
Results Of the 198 patients, 34 (17.2%) had rebleeding after
variceal eradication. The mean duration from variceal eradication
to recurrence of bleeding was 5.4 years. The causes of
rebleeding were: recurrent esophageal varices in 21 patients,
fundal varices in eight, portal gastropathy in three, and
ectopic varices in two patients. Esophageal varices reappeared
in 39 (19.7%) patients. Fundal varices appeared in 19 (9.5%)
patients during follow-up.
Conclusions EST is an effective treatment modality for
bleeding esophageal varices due to EHPVO. During a follow-
up of nearly 20 years after variceal eradication, only about
one-sixth of the patients had recurrence of gastrointestinal bleeding. Bleeding was unusual after 10 years had passed since initial variceal eradication.
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Keywords
Extrahepatic portal venous obstruction, natural history, sclerotherapy
Citation
Thomas Varghese, Jose Tony, Kumar Sunil. Natural history of bleeding after esophageal variceal eradication in patients with extrahepatic portal venous obstruction; a 20-year follow-up. Indian Journal of Gastroenterology. 2009 Nov-Dec; 28(6): 206-211.