Comparison of three nonsurgical treatments for bleeding esophageal varices

K. W. O'Connor, Glen Lehman, H. Yune, R. Brunelle, P. Christiansen, J. Hast, M. Compton, R. McHenry, E. Klatte, E. Cockerill, R. Holden, G. Becker, K. Kopecky, R. Hawes, D. Pound, Douglas Rex, A. Lui, P. Snodgrass, R. Weddle, David CrabbL. Lumeng

Research output: Contribution to journalArticle

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Abstract

Ninety-seven patients with recent or active variceal bleeding were randomly assigned to oral propranolol, endoscopic sclerotherapy plus oral propranolol, or transhepatic sclerotherapy plus oral propranolol. The effects of treatment on the number of units transfused, rebleeding of any magnitude, major rebleeding, and death were assessed in these patients, 82% of whom were alcoholic and 81% Child's Class C. After a minimum follow-up interval of 2 yr (range, 27-65 mo), major rebleeding rates were 65% for propranolol alone, 45% for endoscopic sclerotherapy plus propranolol, and 60% for transhepatic sclerotherapy plus propranolol. The corresponding death rates were 81% for propranolol alone, 55% for endoscopic sclerotherapy plus propranolol, and 66% for transhepatic sclerotherapy plus propranolol (p = 0.03). Thirty-three patients (34%) never received propranolol: 8 due to medical contraindications and 25 because they died or bled enough to meet the definition of treatment failure within 3 or 4 days of randomizations (no significant differences among treatment groups). Patients assigned to propranolol alone bled sooner, bled more units, and had a higher mortality rate than patients treated by endoscopic sclerotherapy plus propranolol. Patients treated with transhepatic sclerotherapy plus propranolol had intermediate results. Propranolol alone is inadequate treatment for esophageal variceal bleeding in patients with advanced liver disease.

Original languageEnglish (US)
Pages (from-to)899-906
Number of pages8
JournalGastroenterology
Volume96
Issue number3
DOIs
StatePublished - Jan 1 1989

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Esophageal and Gastric Varices
Propranolol
Hemorrhage
Sclerotherapy
Therapeutics
Mortality
Random Allocation
Treatment Failure
Liver Diseases

ASJC Scopus subject areas

  • Gastroenterology

Cite this

O'Connor, K. W., Lehman, G., Yune, H., Brunelle, R., Christiansen, P., Hast, J., ... Lumeng, L. (1989). Comparison of three nonsurgical treatments for bleeding esophageal varices. Gastroenterology, 96(3), 899-906. https://doi.org/10.1016/0016-5085(89)90919-0

Comparison of three nonsurgical treatments for bleeding esophageal varices. / O'Connor, K. W.; Lehman, Glen; Yune, H.; Brunelle, R.; Christiansen, P.; Hast, J.; Compton, M.; McHenry, R.; Klatte, E.; Cockerill, E.; Holden, R.; Becker, G.; Kopecky, K.; Hawes, R.; Pound, D.; Rex, Douglas; Lui, A.; Snodgrass, P.; Weddle, R.; Crabb, David; Lumeng, L.

In: Gastroenterology, Vol. 96, No. 3, 01.01.1989, p. 899-906.

Research output: Contribution to journalArticle

O'Connor, KW, Lehman, G, Yune, H, Brunelle, R, Christiansen, P, Hast, J, Compton, M, McHenry, R, Klatte, E, Cockerill, E, Holden, R, Becker, G, Kopecky, K, Hawes, R, Pound, D, Rex, D, Lui, A, Snodgrass, P, Weddle, R, Crabb, D & Lumeng, L 1989, 'Comparison of three nonsurgical treatments for bleeding esophageal varices', Gastroenterology, vol. 96, no. 3, pp. 899-906. https://doi.org/10.1016/0016-5085(89)90919-0
O'Connor, K. W. ; Lehman, Glen ; Yune, H. ; Brunelle, R. ; Christiansen, P. ; Hast, J. ; Compton, M. ; McHenry, R. ; Klatte, E. ; Cockerill, E. ; Holden, R. ; Becker, G. ; Kopecky, K. ; Hawes, R. ; Pound, D. ; Rex, Douglas ; Lui, A. ; Snodgrass, P. ; Weddle, R. ; Crabb, David ; Lumeng, L. / Comparison of three nonsurgical treatments for bleeding esophageal varices. In: Gastroenterology. 1989 ; Vol. 96, No. 3. pp. 899-906.
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abstract = "Ninety-seven patients with recent or active variceal bleeding were randomly assigned to oral propranolol, endoscopic sclerotherapy plus oral propranolol, or transhepatic sclerotherapy plus oral propranolol. The effects of treatment on the number of units transfused, rebleeding of any magnitude, major rebleeding, and death were assessed in these patients, 82{\%} of whom were alcoholic and 81{\%} Child's Class C. After a minimum follow-up interval of 2 yr (range, 27-65 mo), major rebleeding rates were 65{\%} for propranolol alone, 45{\%} for endoscopic sclerotherapy plus propranolol, and 60{\%} for transhepatic sclerotherapy plus propranolol. The corresponding death rates were 81{\%} for propranolol alone, 55{\%} for endoscopic sclerotherapy plus propranolol, and 66{\%} for transhepatic sclerotherapy plus propranolol (p = 0.03). Thirty-three patients (34{\%}) never received propranolol: 8 due to medical contraindications and 25 because they died or bled enough to meet the definition of treatment failure within 3 or 4 days of randomizations (no significant differences among treatment groups). Patients assigned to propranolol alone bled sooner, bled more units, and had a higher mortality rate than patients treated by endoscopic sclerotherapy plus propranolol. Patients treated with transhepatic sclerotherapy plus propranolol had intermediate results. Propranolol alone is inadequate treatment for esophageal variceal bleeding in patients with advanced liver disease.",
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AU - O'Connor, K. W.

AU - Lehman, Glen

AU - Yune, H.

AU - Brunelle, R.

AU - Christiansen, P.

AU - Hast, J.

AU - Compton, M.

AU - McHenry, R.

AU - Klatte, E.

AU - Cockerill, E.

AU - Holden, R.

AU - Becker, G.

AU - Kopecky, K.

AU - Hawes, R.

AU - Pound, D.

AU - Rex, Douglas

AU - Lui, A.

AU - Snodgrass, P.

AU - Weddle, R.

AU - Crabb, David

AU - Lumeng, L.

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N2 - Ninety-seven patients with recent or active variceal bleeding were randomly assigned to oral propranolol, endoscopic sclerotherapy plus oral propranolol, or transhepatic sclerotherapy plus oral propranolol. The effects of treatment on the number of units transfused, rebleeding of any magnitude, major rebleeding, and death were assessed in these patients, 82% of whom were alcoholic and 81% Child's Class C. After a minimum follow-up interval of 2 yr (range, 27-65 mo), major rebleeding rates were 65% for propranolol alone, 45% for endoscopic sclerotherapy plus propranolol, and 60% for transhepatic sclerotherapy plus propranolol. The corresponding death rates were 81% for propranolol alone, 55% for endoscopic sclerotherapy plus propranolol, and 66% for transhepatic sclerotherapy plus propranolol (p = 0.03). Thirty-three patients (34%) never received propranolol: 8 due to medical contraindications and 25 because they died or bled enough to meet the definition of treatment failure within 3 or 4 days of randomizations (no significant differences among treatment groups). Patients assigned to propranolol alone bled sooner, bled more units, and had a higher mortality rate than patients treated by endoscopic sclerotherapy plus propranolol. Patients treated with transhepatic sclerotherapy plus propranolol had intermediate results. Propranolol alone is inadequate treatment for esophageal variceal bleeding in patients with advanced liver disease.

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