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document
A comparison of sclerotherapy with staple transection of the esophagus for the emergency control of bleeding from esophageal varices . We compared two procedures for the emergency treatment of bleeding esophageal varices in patients who did not respond to blood transfusion and vasoactive drugs . We randomly assigned 101 patients with cirrhosis of the liver and bleeding esophageal varices to undergo either emergency sclerotherapy ( n = 50 ) or staple transection of the esophagus ( n = 51 ) . Four patients assigned to sclerotherapy and 12 assigned to staple transection did not actually undergo those procedures , but all analyses were made on an intention-to-treat basis . Total mortality did not differ significantly between the two groups ; the relative risk of death for staple transection as compared with sclerotherapy was 0.88 ( 95 percent confidence interval , 0.51 to 1.54 ) . Mortality at six weeks was 44 percent among those assigned to sclerotherapy and 35 percent among those assigned to staple transection . Complication rates were similar for the two groups . An interval of five days without bleeding was achieved in 88 percent of those assigned to staple transection and in 62 percent of those assigned to sclerotherapy after a single injection ( P less than 0.01 ) and 82 percent after three injections . In only 2 of the 11 patients who received a third sclerotherapy injection was bleeding controlled for more than five days , and 9 died . We conclude that staple transection of the esophagus is as safe as sclerotherapy for the emergency treatment of bleeding esophageal varices and that it is more effective than a single sclerotherapy procedure . We currently recommend surgery after two injection treatments have failed .
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Intervention_Surgical
sclerotherapy
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Intervention_Surgical
staple transection of the esophagus
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Intervention_Surgical
undergo either emergency sclerotherapy
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Intervention_Surgical
staple transection of the esophagus
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Intervention_Surgical
sclerotherapy
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Intervention_Surgical
sclerotherapy
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Intervention_Surgical
sclerotherapy
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Intervention_Surgical
sclerotherapy
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Intervention_Surgical
sclerotherapy
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Outcome_Physical
control of bleeding
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Outcome_Physical
bleeding
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Outcome_Mortality
Total mortality
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Outcome_Mortality
relative risk of death
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Outcome_Mortality
Mortality
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Outcome_Physical
Complication rates
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Outcome_Physical
interval of five days without bleeding
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Outcome_Physical
bleeding controlled
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Outcome_Other
safe as sclerotherapy
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Outcome_Physical
emergency treatment of bleeding
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Participant_Condition
bleeding from esophageal varices
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Participant_Condition
bleeding esophageal varices in patients who did not respond to blood transfusion and vasoactive drugs
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Participant_Sample-size
101 patients
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Participant_Condition
with cirrhosis of the liver and bleeding esophageal varices