The use of sclerotherapy for the management of oesophageal varices in portal hypertension |
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Authors: | John Terblanche |
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Institution: | (1) Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa;(2) Medical Research Council, Liver Research Centre, University of Cape Town, Cape Town, South Africa |
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Abstract: | Summary Although sclerotherapy is currently the most widely used treatment for the management of both acute variceal bleeding and
the long-term management of patients with varices, its definitive role in the treatment of these patients has yet to be finally
proven. Sclerotherapy appears to be the most effective treatment for the majority of patients with acute variceal bleeding.
Failures require either a shunt or a transection and/or devascularisation procedure. Current evidence favours simple staple
gun transection or a shunt (either a portacaval shunt or a side-to-side narrow diameter polytetrafluoroethylene graft between
the portal vein and vena cava). In long-term management of patients after a variceal bleed the currently favoured treatment
is repeated sclerotherapy. However, failures should be identified early. We define failures as patients who present with varices
that are either difficult to eradicate by sclerotherapy or who have repeated life-threatening variceal bleeds during the course
of repeated injection sclerotherapy. Such patients should have either a portal-to-systemic shunt or a transection and devascularisation
operation. Further controlled trials are required to define the specific indications for the individual forms of therapy.
Prophylactic treatment for varices that have not yet bled is unjustified at present.
Based on a presentation to the International Congress on Surgical Endoscopy, Ultrasound, and Interventional Techniques, Berlin
1988 |
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Keywords: | Portal hypertension Sclerotherapy Oesophageal varices |
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