OBJECTIVE: To compare three options for the elective treatment of portal hypertension during a 10-year period. METHODS:Patients included in the trial were 18 to 76 years old, had a history of bleeding portal hypertension, and had undergone no prior treatment. Treatment options were beta-blockers (propranolol), sclerotherapy, and portal blood flow-preserving procedures (selective shunts and the Sugiura-Futagawa operation). RESULTS:A total of 119 patients were included: 40 in the pharmacology group, 46 in the sclerotherapy group,and 33 in the surgical group. The three groups showed no differences in terms of age, Child-Pugh classification, and cause of liver disease. The rebleeding rate was significantly lower in the surgical group than in the other two groups. The rebleeding rate was only 5% in the Child A surgical group, compared with 71% and 68% for the sclerotherapy and pharmacotherapy groups, respectively. Survival was better for the low-risk patients (Child A) in the three groups, but when the three options were compared, no significant difference was found. CONCLUSIONS:Portal blood flow-preserving procedures offer the lowest rebleeding rate in low-risk patients undergoing elective surgery.
RCT Entities:
OBJECTIVE: To compare three options for the elective treatment of portal hypertension during a 10-year period. METHODS:Patients included in the trial were 18 to 76 years old, had a history of bleeding portal hypertension, and had undergone no prior treatment. Treatment options were beta-blockers (propranolol), sclerotherapy, and portal blood flow-preserving procedures (selective shunts and the Sugiura-Futagawa operation). RESULTS: A total of 119 patients were included: 40 in the pharmacology group, 46 in the sclerotherapy group,and 33 in the surgical group. The three groups showed no differences in terms of age, Child-Pugh classification, and cause of liver disease. The rebleeding rate was significantly lower in the surgical group than in the other two groups. The rebleeding rate was only 5% in the Child A surgical group, compared with 71% and 68% for the sclerotherapy and pharmacotherapy groups, respectively. Survival was better for the low-risk patients (Child A) in the three groups, but when the three options were compared, no significant difference was found. CONCLUSIONS: Portal blood flow-preserving procedures offer the lowest rebleeding rate in low-risk patients undergoing elective surgery.
Authors: J M Henderson; M H Kutner; W J Millikan; J T Galambos; S P Riepe; W S Brooks; F C Bryan; W D Warren Journal: Ann Intern Med Date: 1990-02-15 Impact factor: 25.391
Authors: J M Henderson; G T Gilmore; M A Hooks; J R Galloway; T F Dodson; M M Hood; M H Kutner; T D Boyer Journal: Ann Surg Date: 1992-09 Impact factor: 12.969
Authors: M A Mercado; H Orozco; F J Ramírez-Cisneros; C A Hinojosa; J J Plata; J Alvarez-Tostado Journal: J Gastrointest Surg Date: 2001 Sep-Oct Impact factor: 3.452
Authors: Jisheng Chen; Jinshan Huo; Hongwei Zhang; Changzhen Shang; Rufu Chen; Jie Zhang; Mapudengo Obetien; Yajin Chen; Lei Zhang Journal: Front Med China Date: 2007-02-01