Endoscopic variceal sclerotherapy in patients with Symmers periportal fibroses

Abstract

This is a prospective study, carried out in patients with portal hypertension and bleeding oesophageal varices secondary to Symmers (Schistosomal) periportal fibroses, to determine the efficacy of sclerotherapy, the number of sessions needed to achieve full sclerosis, the complications associated with sclerotherapy and the incidence and risk factors for rebleeding. In total, 85 patients were studied with a mean age of 38 years, 76.5% were males. All underwent upper gastrointestinal endoscopy, had different grades of oesophageal varices and underwent intravariceal injection with 5% ethanolamine oleate until they achieved full sclerosis or were referred to surgery. Complications of sclerotherapy included oesophageal strictures, deep oesophageal ulcers, pleural effusion and ascites. Following obliteration of oesophageal varices, 3.5% and 20% developed new gastric varices and portal gastropathy, respectively. Rebleeding occurred in 32% - the only significant predictive risk factor for which was patients with GIII varices following the first sclerotherapy session. Varices recurred in 6% of patients after a mean follow-up period of one year. In total, 93% of our patients achieved full sclerosis after an average of four sessions, and 3.5% were referred for surgery. Three patients (3.5%) died, all from massive rebleeding. In conclusion, sclerotherapy is a safe effective method for treating patients with oesophageal varices due to periportal fibroses.

Mortality and rebleeding following variceal haemorrhage in liver cirrhosis and periportal fibrosis

“…Significant factors contributing to the 6-wk rebleeding rate in PPF group were grade III PPF on abdominal ultrasound and blood transfusion on admission ( P value < 0.004 and < 0.02 respectively). A previous study from Sudan demonstrated that rebleeding was more in grade III PPF[17]. A study from Brazil also found that the sonographic grade of periportal fibrosis was an important tool in predicting variceal complications in patients with schistosomal PPF[18], whereas the longitudinal spleen dimension of more than 11 cm, was an important tool in predicting variceal bleeding in another study[6].…”

Bleeding Oesophageal Varices, Clinical Presentation and Outcome of Management in Wad Madani Teaching Hospital.

“…Up to 30% of bleeding episodes are fatal, while in this study it was seen in 6% of patients after receiving treatment in the form of pharmacotherapy and endoscopic treatment, which is comparable to Mudawi study (3.5%). (38) In this study it was found that most of the patients were farmers (80%) and living nearby the Blue Nile and its irrigating canal system. According to WMTH statistics, in the last eight years the total number of patients with oesophageal varices were 1140 and 947 of them were from Gezira state accounting for 83% of patients, which is an endemic area for schistosomiasis.…”

“…The recurrence rate in this study was 17 patients (22.6%), while it was seen in 32% in Mudawi`s study. (38) Conclusions & Recommendations:-Conclusions:- The main presentation of bleeding oesophageal varices is haematemesis, however it can present with melaena.  Pancytopenia and splenomegaly are highly associated with bleeding oesophageal varices.…”

Surgical outcomes of distal splenorenal shunt or liver transplantation in treatment of schistosomal refractory variceal bleeding

“…Also, endoscopic therapy has poorer long-term results although it's less invasive than surgery [126,127] . Furthermore, in 2007 Mudawi and Ibrahim [128] found high rates of variceal rebleeding in 32% of patients with schistosomiasis treated by endoscopic sclerotherapy for secondary prophylaxis and mortality rate was three and a half percent.…”