Disability index in a randomized controlled trial of emergency sclerotherapy versus portacaval shunt for bleeding varices in cirrhosis - 17/07/12
, Jon I. Isenberg, M.D. b, Henry O. Wheeler, M.D. b, Kevin S. Haynes, M.D. b, Horacio Jinich-Brook, M.D. b, Roderick Rapier, M.D. b, Florin Vaida, Ph.D. c, Robert J. Hye, M.D. a, Susan L. Orloff, M.D. d
Corresponding author. Tel.: +1-619-543-5865; fax: +1-619-543-6253Abstract |
Background |
Disability has not been studied after emergency treatment of bleeding esophageal varices (BEV). We created a disability index (DI) in a randomized controlled trial comparing emergency endoscopic therapy (EST) versus emergency portacaval shunt (EPCS).
Methods |
There were 211 unselected, consecutive patients with cirrhosis and acute BEV who were randomized to EST (n = 106) or EPCS (n = 105). Diagnostic work-up and treatment were performed within 8 hours. Ninety-six percent underwent more than 10 years follow-up evaluation. Disability was measured by assessing 9 factors to create a DI.
Results |
Ten-year survival was 8% after EST versus 51% after EPCS (P < .001). EPCS had a significantly better DI. The EST and EPCS values were as follows: liver function improvement: not applicable and ++; worsening liver function, ++ and not applicable; portal-systemic encephalopathy (PSE) incidence, 36 and 15; PSE episodes, 179 and 94; packed red blood cell units, 1,005 and 320; hospital readmissions, 387 and 292; and number of readmission days, 9.6 and 4.7. All of the P values were less than .001.
Conclusions |
EPCS resulted in a markedly better DI than EST, a significantly higher survival rate, better control of bleeding, and a lower incidence of PSE. EPCS is an effective first-line emergency treatment of BEV.
Le texte complet de cet article est disponible en PDF.Keywords : Quality of life, Bleeding varices, Endoscopic sclerotherapy, Portacaval shunt
Plan
| There were no competing interests relevant to this article on the part of any of the authors and no financial interests, relationships, or affiliations. |
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| Author contributions were as follows: Marshall Orloff, Jon Isenberg, and Henry Wheeler were responsible for the study conception and design; Marshall Orloff, Jon Isenberg, Kevin Haynes, Horacio Jinich-Brook, Roderick Rapier, and Robert Hye were responsible for data acquisition; Marshall Orloff, Jon Isenberg, Florin Vaida, and Susan Orloff were responsible for the analysis and interpretation of data; Marshall Orloff, Kevin Haynes, Florin Vaida, Robert Hye, and Susan Orloff were responsible for drafting of the manuscript; and Marshall Orloff, Kevin Haynes, Horacio Jinich-Brook, Florin Vaida, Robert Hye, and Susan Orloff were responsible for critical revision of the manuscript. |
Vol 204 - N° 2
P. 157-166 - août 2012 Retour au numéro
Article précédent
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