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• W2068203838 abstract "Editorials15 February 1990Prevention of Recurrent Variceal Bleeding—Is Surgical Rescue the Answer?Norman D. Grace, MDNorman D. Grace, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-4-242 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptBleeding from esophageal varices continues to be a major complication of cirrhosis and portal hypertension, with the mortality for a bleeding episode close to 50% (1). Although the risk for first hemorrhage after discovery of esophageal varices is 25% to 30%, the risk for recurrent variceal hemorrhage after control of the initial bleeding episode is close to 70% (2). Most episodes of recurrent hemorrhage occur within 1 year of the initial episode. Because of the high morbidity associated with variceal bleeding, there is considerable interest in finding a therapy that will both prevent variceal bleeding and improve survival.Several prospective...References1. GrahamSmith DJ. The course of patients after variceal hemorrhage. Gastroenterology. 1981;80:800-9. CrossrefMedlineGoogle Scholar2. Grace N. The prevention of initial variceal bleed: the knife, the scope, or the pill. In: Najarian JS, Delaney JP, eds. Progress in Hepatic Biliary and Pancreatic Surgery. Chicago: Yearbook Medical Publishers; 1990 [In press]. Google Scholar3. JacksonPerrinFelixSmith FEWA. A clinical investigation of the portacaval shunt. V. Survival analysis of the therapeutic operation. Ann Surg. 1971;174:672-701. CrossrefMedlineGoogle Scholar4. ResnickIberIshiharaChalmersZimmerman RFATH. A controlled study of the therapeutic portacaval shunt. Gastroenterology. 1974;67:843-57. CrossrefMedlineGoogle Scholar5. ReynoldsDonovanMikkelsenRedekerTurrillWeiner TAWAFJ. Results of a 12-year randomized trial of portacaval shunt in patients with alcoholic liver disease and bleeding varices. Gastroenterology. 1981 ;80:1005-11. CrossrefMedlineGoogle Scholar6. RueffPrandiDegos BDF. A controlled study of therapeutic portacaval shunt in alcoholic cirrhosis. Lancet. 1976;1:655-9. CrossrefMedlineGoogle Scholar7. BarsoumBoulosEl-RoobyRizk-AllahIbrahim MFAMA. Tamponade and injection sclerotherapy in the management of bleeding oesophageal varices. Br J Surg. 1982;69:76-8. CrossrefMedlineGoogle Scholar8. Sclerotherapy after first variceal hemorrhage in cirrhosis. A randomized multicenter trial. The Copenhagen Esophageal Varices Sclerotherapy Project. N Engl J Med. 1984;311:1594-600. CrossrefMedlineGoogle Scholar9. SoderlundIhre CT. Endoscopic sclerotherapy v. conservative management of bleeding oesophageal varices. A 5-year prospective controlled trial of emergency and long-term treatment. Acta Chir Scand. 1985;151:449-56. MedlineGoogle Scholar10. PaquetFeussner KH. Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: a prospective controlled randomized trial. Hepatology. 1985;5:580-3. CrossrefMedlineGoogle Scholar11. TerblancheBornmanKahn JPD. Failure of repeated injection sclerotherapy to improve long-term survival after oesophageal variceal bleeding. A five-year prospective controlled clinical trial. Lancet. 1983;2:1328-32. CrossrefMedlineGoogle Scholar12. WestabyMacdougallWilliams DBR. Improved survival following injection sclerotherapy for oesophageal varices: final analysis of a controlled trial. Hepatology. 1985;5;827-30. CrossrefMedlineGoogle Scholar13. KorulaBalartRadvan JLG. A prospective, randomized controlled trial of chronic esophageal variceal sclerotherapy. Hepatology. 1985;5:584-9. CrossrefMedlineGoogle Scholar14. LebrecPoynardBernuau DTJ. A randomized controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a final report. Hepatology. 1984;4:355-8. CrossrefMedlineGoogle Scholar15. Colombode FranchisTommasiniSangiovanniDioguardi MRMAN. B-blockade prevents recurrent gastrointestinal bleeding in well-compensated patients with alcoholic cirrhosis: a multicenter randomized controlled trial. Hepatology. 1989;9:433-8. CrossrefMedlineGoogle Scholar16. GattaMerkelSacerdoti ACD. Nadolol for prevention of variceal bleeding in cirrhosis: a controlled clinical trial. Digestion. 1987;37:22-8. CrossrefMedlineGoogle Scholar17. MarbetStraumannGyr UAK. Reduction in early recurrence of variceal bleeding by propranolol. Scand J Gastroenterol. 1988;23:369-74. CrossrefMedlineGoogle Scholar18. BurroughsJenkinsSherlock AWS. Controlled trial of propranolol for the prevention of recurrent variceal hemorrhage in patients with cirrhosis. N Engl J Med. 1983;309:1539-42. CrossrefMedlineGoogle Scholar19. VilleneuvePomier-LayrarguesInfante-Rivard JGC. Propranolol for the prevention of recurrent variceal hemorrhage: a controlled trial. Hepatology. 1986;6:1239-43. CrossrefMedlineGoogle Scholar20. QueunietCzernichowLereboursDucrotteTranvouezColin APEPJR. Etude controles du propranolol dans la prevention des recidives hemorragiques chez les patients cirrhotiques. Gastroenterol Clin Biol. 1987;11:41-7. MedlineGoogle Scholar21. Grace N. Variceal hemorrhage: pharmacologic approach. In: McDermott WV, Bothe A, eds. Surgery of the Liver. Boston: Blackwell Scientific Publications, Inc.; 1988:303-14. Google Scholar22. HendersonKutnerMillikan JMW. Endoscopic variceal sclerosis compared with distal splenorenal shunt to prevent recurrent variceal bleeding in cirrhosis. Ann Intern Med. 1989;112[In press]. MedlineGoogle Scholar23. WarrenHendersonMillikan WJW. Distal splenorenal shunt versus endoscopic sclerotherapy for long-term management of variceal bleeding. Preliminary report of a prospective randomized trial. Ann Surg. 1986;203:454-62. CrossrefMedlineGoogle Scholar24. RikkersBurnettVolentineBuchiCormier LDGKR. Shunt surgery versus endoscopic sclerotherapy for long-term treatment of variceal bleeding. Early results of a randomized trial. Ann Surg. 1987;206:261-71. CrossrefMedlineGoogle Scholar25. TeresBordasBravo JJD. Sclerotherapy vs. distal splenorenal shunt in the elective treatment of variceal hemorrhage: a randomized controlled trial. Hepatology. 1987;7:430-6. CrossrefMedlineGoogle Scholar26. CelloGrendellCrassWeberTrunkey JJRTD. Endoscopic sclerotherapy versus portocaval shunt in patients with severe cirrhosis and acute variceal hemorrhage. Long-term follow-up. N Engl J Med. 1987;316:11-5. CrossrefMedlineGoogle Scholar27. GraceConnResnick NHR. Distal splenorenal vs. portal-systemic shunts after hemorrhage from varices: a randomized controlled trial. Hepatology. 1988;8:1475-81. CrossrefMedlineGoogle Scholar28. SpinaGaleottiOpocher GFE. Selective distal splenorenal shunt versus side-to-side portacaval shunt. Clinical results of a prospective, controlled study. Am J Surg. 1988;155:564-71. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Faulkner and Lemuel Shattuck Hospitals Tufts University School of Medicine Boston, MA 02130 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 February 1990Volume 112, Issue 4Page: 242-244 Issue Published: 15 February 1990 PDF DownloadLoading ..." @default.
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