[Sclerosis of esophageal varices. Results of 10 years experience].

Abstract

Before they give their results, the authors, whose experience of sclerosis of oesophageal varices under the oesophagoscope has so far involved 157 patients, deal specifically with the problems facing the anaesthetist and resuscitator when this technique is used, tolerance of the product injected and possible accidents. Firstly, they point out the unsuitability of the patients referred to them by their medical or surgical colleagues. By implication therefore, treatment should only be undertaken with the assistance of a team of experienced resuscitators and every precaution taken to mitigate the effects of possible accidents to these patients who are particularly at risk. These cases are mainly characterized by serious haemorrhages (seven cases described, one resulting in death). Oesophageal injury is, on the other hand, the exception where trained personnel are involved (2 minor mucosal tears out of more than 800 oesophagoscopies). Finally, secondary parietal oesophageal necrosis occurs. Quininaemia assessment after injection of quinine-urea confirms that the product is being efficiently eliminated. Overall results reveal a survival rate of 61 p. 100 after more than a year and 20 p. 100 after more than than three years. These figures underline the limitations of therapeutic possibilities and the serious prognosis for this result of portal hypertension. This leads the authors to express a wish that the procedure should be used as a measure to prevent haemorrhage as soon as the presence of varices is realized. On the other hand, they reject on practical grounds emergency sclerosis of oesophageal varices, as a direct heamostatic method, since, according to their statistics, this almost invariably results in failure.