The efficacy of endoscopic ligation for the prevention of variceal rebleeding in cirrhotic patients according to the hepatocellular function.

BACKGROUND/AIMS: Endoscopic variceal ligation is considered the leading therapy for the prevention of variceal rebleeding in cirrhotic patients. However, the efficacy of this method in cirrhotic patients with poor hepatocellular function is not well-known yet. The aim of this study is to compare the efficacy of endoscopic variceal ligation for the eradication of esophageal varices, rebleeding and mortality rates, based on hepatocellular function, as graded by Child-Pugh. METHODOLOGY: Between June 1996 and December 2001, 163 consecutive cirrhotic patients were submitted to band ligation at our Department. Of these cases, 128 patients with previous variceal bleeding (mean age = 50.7 years; 90 males and 38 females) were followed-up. 55 patients were graded as Child A, 49 as Child B and 24 as Child C. RESULTS: The mean follow-up period for all groups was 17.3 months. Varices were eradicated in 82.7% (86 of 104 cases) of Child A/B cirrhotic patients and in 54.2% (13 of 24 cases) of Child C cases (p=0.0061). Eradication was achieved after a mean of 3.7 sessions, and no difference was observed among the groups. Varices recurred in 38.4% (38 of 99 cases) of the patients, presenting no difference among the different Child classes. However, there was a trend to a higher rebleeding rate among patients with variceal recurrence (21% vs. 8.2%, p=0.075). Rebleeding occurred in 20.2% (21 of 104 cases) of Child A/B cirrhotics and in 41.7% (10 of 24 cases) of Child C patients (p=0.001 log-rank test). The mortality rate was 13.5% (14 of 104 cases) among Child A/B patients and 37.5% (9 of 24 cases) among Child C cases (p=0.0135). CONCLUSIONS: Endoscopic variceal ligation is an effective method for the prevention of rebleeding in patients with better liver function. Child C patients had a poor response to treatment. These patients, in a statistically significant fashion, had a worse eradication rate and greater rebleeding and mortality rates than Child A/B patients.

Alterações neurológicas em pacientes submetidos a transplante hepático: análise de 30 casos consecutivos / Neurologic alterations in patients submitted to liver transplantation: analysis of 30 consecutive cases

As complicações neurológicas em transplante hepático (TxH) são importante causa de morbi-mortalidade, pois as intercorrências podem resultar de fatores prévios ao TxH, de alterações trans-operatórias, de dificuldades com os imunossupressores, coagulopatias e infecções do período pós-operatório. Nós analisamos , retrospectivamente, a cronologia, as causas e as frequências das alterações neurológicas de 30 pacientes adultos submetidos a TxH e constatamos que nossos resultados diferem ligeiramente dos apresentados em outras séries.

Evolução intra-hospitalar dos pacientes cirróticos com sangramento agudo por vrizes esofágicas submetidos à escleroterapia endoscópica / In-hospital evolution of cirrhotic patients with acute bleeding due to esophageal varices submitted to endoscopic sclerotherapy

Oobjetivo do presente estudo é avaliar a evolução intra-hospitalar dos pacientes que sangraram por ruptura de varizes de esôfago (VE) quando submetidos à escleroterapia endoscópica das varizes esofágicas (EEVE), bem como determinar a frequência do sangramento por ruptura destas varizes em uma população de pacientes com hemorragia digestiva alta (HDA). Para tanto, foram avaliados 451 pacientes com HdA. Destes 69 sangraram por ruptura de VE (15,3por centos). O álcool e o vírus C foram os vatores mais frequentemente envolvidos na etiologia da cirrose. Quanto ao estado funcional hepático, dez foram classificados como Child-Pugh A, 28 Child-Pugh B e 26 Child-Pugh C. A maioria destes 69 pacientes cirroticos já haviam apresentado sangramento prévio de VE. Dos 69 pacientes que sangraram por VE, 55 foram submetidos à escleroterapia endoscopica de varizes de esôfago. O sucesso do procedimento em controlar o sangramento foi de 83,6por cento; eno entanto, a mortalidade hospitalar foi de 47,3por cento. Conclui-se que a hemorragia digestiva pr ruptura de VE é uma situação frequente e que implica péssimo prognóstico aos pacientes com cirrose.GED 19(5):188-192,2000