Alcoholic versus nonalcoholic cirrhosis in a randomized controlled trial of emergency therapy of bleeding varices

Marshall J. Orloff; Jon I. Isenberg; Henry O. Wheeler; Kevin S. Haynes; Horacio Jinich-Brook; Roderick Rapier; Florin Vaida; Robert J. Hye; Susan L. Orloff

doi:10.1016/j.jss.2010.11.007

Alcoholic versus nonalcoholic cirrhosis in a randomized controlled trial of emergency therapy of bleeding varices

Marshall J. Orloff
, Jon I. Isenberg
, Henry O. Wheeler
, Kevin S. Haynes
, Horacio Jinich-Brook
, Roderick Rapier
, Florin Vaida
, Robert J. Hye
, Susan L. Orloff

Surgery

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Background: It has been proposed that portal-systemic shunts be avoided in alcoholic cirrhotics because survival rate is allegedly lower in alcoholics than in nonalcoholics. We examined this issue in a randomized controlled trial. Methods: Two hundred eleven unselected, consecutive patients with cirrhosis and bleeding esophageal varices were randomized to endoscopic sclerotherapy (EST) (n = 106) or emergency portacaval shunt (EPCS) (105). Treatment was initiated within 8 h. EST failure was treated by rescue portacaval shunt (PCS). Ten-year follow-up was 96%. Results: Results strongly favored EPCS over EST (P < 0.001). Among EPCS patients, 83% were alcoholic and 17% nonalcoholic. Outcomes were (1) permanent control of bleeding 100% versus 100%; (2) 5-y survival 71% versus 78%; (3) encephalopathy 14% versus 19%; (4) yearly charges $38,300 versus $43,000. Conclusions: EPCS results were similar in alcoholic and nonalcoholic cirrhotics. EPCS is an effective first line emergency treatment in all forms of cirrhosis, including alcoholic.

Original language	English (US)
Pages (from-to)	98-105
Number of pages	8
Journal	Journal of Surgical Research
Volume	174
Issue number	1
DOIs	https://doi.org/10.1016/j.jss.2010.11.007
State	Published - May 1 2012

Funding

This work was supported in party by Health Resources and Services Administration contract 234-2005-370011C, and by grant 1R01 DK41920 from the National Institutes of Health and a grant ( 501(c)(3) from the Surgical Education and Research Foundation . The sponsors played no role in the conduct of the study or in this report of the results and analysis. The authors thank the many residents in the Department of Medicine and the Department of Surgery at UCSD Medical Center who played a major role in the care of patients in this study. They thank Professors Harold O. Conn, Haile T. Debas, and Peter Gregory, who served voluntarily as an External Advisory and Monitoring Committee. They thank the many physicians practicing in the counties of San Diego, Imperial, Orange, and Riverside, who helped with patient recruitment, referral, and long-term follow-up. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

Funders	Funder number
Surgical Education and Research Foundation
Author National Institutes of Health National Institutes of Health National Institutes of Health National Institutes of Health The Bev Hartig Huntington's Disease Foundation National Institutes of Health
National Institute of Diabetes and Digestive and Kidney Diseases	R01DK041920
Health Resources and Services Administration	1R01 DK41920, 234-2005-370011C

Keywords

alcoholic
bleeding esophageal varices
cirrhosis
emergency portacaval shunt
endoscopic sclerotherapy
nonalcoholic

ASJC Scopus subject areas

Surgery

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10.1016/j.jss.2010.11.007

Cite this

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title = "Alcoholic versus nonalcoholic cirrhosis in a randomized controlled trial of emergency therapy of bleeding varices",

abstract = "Background: It has been proposed that portal-systemic shunts be avoided in alcoholic cirrhotics because survival rate is allegedly lower in alcoholics than in nonalcoholics. We examined this issue in a randomized controlled trial. Methods: Two hundred eleven unselected, consecutive patients with cirrhosis and bleeding esophageal varices were randomized to endoscopic sclerotherapy (EST) (n = 106) or emergency portacaval shunt (EPCS) (105). Treatment was initiated within 8 h. EST failure was treated by rescue portacaval shunt (PCS). Ten-year follow-up was 96\%. Results: Results strongly favored EPCS over EST (P < 0.001). Among EPCS patients, 83\% were alcoholic and 17\% nonalcoholic. Outcomes were (1) permanent control of bleeding 100\% versus 100\%; (2) 5-y survival 71\% versus 78\%; (3) encephalopathy 14\% versus 19\%; (4) yearly charges \$38,300 versus \$43,000. Conclusions: EPCS results were similar in alcoholic and nonalcoholic cirrhotics. EPCS is an effective first line emergency treatment in all forms of cirrhosis, including alcoholic.",

keywords = "alcoholic, bleeding esophageal varices, cirrhosis, emergency portacaval shunt, endoscopic sclerotherapy, nonalcoholic",

author = "Orloff, \{Marshall J.\} and Isenberg, \{Jon I.\} and Wheeler, \{Henry O.\} and Haynes, \{Kevin S.\} and Horacio Jinich-Brook and Roderick Rapier and Florin Vaida and Hye, \{Robert J.\} and Orloff, \{Susan L.\}",

note = "Funding Information: This work was supported in party by Health Resources and Services Administration contract 234-2005-370011C, and by grant 1R01 DK41920 from the National Institutes of Health and a grant ( 501(c)(3) from the Surgical Education and Research Foundation . The sponsors played no role in the conduct of the study or in this report of the results and analysis. The authors thank the many residents in the Department of Medicine and the Department of Surgery at UCSD Medical Center who played a major role in the care of patients in this study. They thank Professors Harold O. Conn, Haile T. Debas, and Peter Gregory, who served voluntarily as an External Advisory and Monitoring Committee. They thank the many physicians practicing in the counties of San Diego, Imperial, Orange, and Riverside, who helped with patient recruitment, referral, and long-term follow-up. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.",

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T1 - Alcoholic versus nonalcoholic cirrhosis in a randomized controlled trial of emergency therapy of bleeding varices

AU - Orloff, Marshall J.

AU - Isenberg, Jon I.

AU - Wheeler, Henry O.

AU - Haynes, Kevin S.

AU - Jinich-Brook, Horacio

AU - Rapier, Roderick

AU - Vaida, Florin

AU - Hye, Robert J.

AU - Orloff, Susan L.

N1 - Funding Information: This work was supported in party by Health Resources and Services Administration contract 234-2005-370011C, and by grant 1R01 DK41920 from the National Institutes of Health and a grant ( 501(c)(3) from the Surgical Education and Research Foundation . The sponsors played no role in the conduct of the study or in this report of the results and analysis. The authors thank the many residents in the Department of Medicine and the Department of Surgery at UCSD Medical Center who played a major role in the care of patients in this study. They thank Professors Harold O. Conn, Haile T. Debas, and Peter Gregory, who served voluntarily as an External Advisory and Monitoring Committee. They thank the many physicians practicing in the counties of San Diego, Imperial, Orange, and Riverside, who helped with patient recruitment, referral, and long-term follow-up. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Background: It has been proposed that portal-systemic shunts be avoided in alcoholic cirrhotics because survival rate is allegedly lower in alcoholics than in nonalcoholics. We examined this issue in a randomized controlled trial. Methods: Two hundred eleven unselected, consecutive patients with cirrhosis and bleeding esophageal varices were randomized to endoscopic sclerotherapy (EST) (n = 106) or emergency portacaval shunt (EPCS) (105). Treatment was initiated within 8 h. EST failure was treated by rescue portacaval shunt (PCS). Ten-year follow-up was 96%. Results: Results strongly favored EPCS over EST (P < 0.001). Among EPCS patients, 83% were alcoholic and 17% nonalcoholic. Outcomes were (1) permanent control of bleeding 100% versus 100%; (2) 5-y survival 71% versus 78%; (3) encephalopathy 14% versus 19%; (4) yearly charges $38,300 versus $43,000. Conclusions: EPCS results were similar in alcoholic and nonalcoholic cirrhotics. EPCS is an effective first line emergency treatment in all forms of cirrhosis, including alcoholic.

AB - Background: It has been proposed that portal-systemic shunts be avoided in alcoholic cirrhotics because survival rate is allegedly lower in alcoholics than in nonalcoholics. We examined this issue in a randomized controlled trial. Methods: Two hundred eleven unselected, consecutive patients with cirrhosis and bleeding esophageal varices were randomized to endoscopic sclerotherapy (EST) (n = 106) or emergency portacaval shunt (EPCS) (105). Treatment was initiated within 8 h. EST failure was treated by rescue portacaval shunt (PCS). Ten-year follow-up was 96%. Results: Results strongly favored EPCS over EST (P < 0.001). Among EPCS patients, 83% were alcoholic and 17% nonalcoholic. Outcomes were (1) permanent control of bleeding 100% versus 100%; (2) 5-y survival 71% versus 78%; (3) encephalopathy 14% versus 19%; (4) yearly charges $38,300 versus $43,000. Conclusions: EPCS results were similar in alcoholic and nonalcoholic cirrhotics. EPCS is an effective first line emergency treatment in all forms of cirrhosis, including alcoholic.

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KW - bleeding esophageal varices

KW - cirrhosis

KW - emergency portacaval shunt

KW - endoscopic sclerotherapy

KW - nonalcoholic

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VL - 174

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JF - Journal of Surgical Research

IS - 1

ER -

Alcoholic versus nonalcoholic cirrhosis in a randomized controlled trial of emergency therapy of bleeding varices

Abstract

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Keywords

ASJC Scopus subject areas

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