Abstract
In cases of esophageal varices in which surgery is not indicated, we studied long term effects of endoscopic injection sclerotherapy (EIS) in comparison with those in cases who were observed to follow their natural course. The criteria of indication for surgery at our clinic include: 1) sufficient possible control of ascites and hepatic encephalopathy, 2) serum bilirubin below 2.0mg/dl, KICG above 0.05, and 3) no evidence of liver cancer. The all subjects in this study were 110, who were regarded as not fulfilling these three criteria for surgery. In 42 cases EIS was carried out, and in 68 cases having esophageal varices with CBF2, 3RCsign (+) only conservative medical treatment was carried out and their course was observed. Eight of 42 cases (19.1%) in the EIS group developed variceal hemorrhages, five of which bled to death and in comparison with the untreated group both the hemorrhage rate and the mortality from hemorrhage was significantly lower. The survival rate at 1 and 2 years in EIS group was 74.9% and 47.0%, respectively. The survival rate was significantly superior to that of the group in which the natural course was only observed. The cause of death in the EIS group was most frequently due to liver cancer, and in the untreated group it was variceal hemorrhage. Based on the above results, EIS is thought to have reduced variceal hemorrhage and mortality from hemorrhage, and is considered to be a useful therapy for prolonging the survival rate in the long term prognosis of those cases unsuitable for surgery.
