Upper GI bleed: bleeding varices: early sclerotherapy reduced rebleeds

Clinical bottom line (level 2b)

  1. Patients with bleeding oesophageal varices who received sclerotherapy within 6 hours of admission compared with after waiting were less likely to rebleed (NNT = 4 at 12 months) .
  2. There was no clear effect on mortality.
Shemesh et al: Journal of Clinical Gastroenterology 1990; 12 (1): 5-9
Expires October 2002

The study

Double-blinded unconcealed quasi-randomised trial ?with intention-to-treat
Setting: university hospital, Israel

84 patients (aged 8 to 103; mean 57, 61% male) with large bleeding oesophageal varices
Control Group: (n = 41, 41 analysed): endoscopy within 6 hours; bleeding treated with balloon tamponade, vasopressin and haemodynamic resuscitation. Patients had sclerotherapy after 24-48 hours.
Experimental Group: (n = 43, 43 analysed): sclerotherapy within 6 hours

100% followed for 30 months range 2 to 86
Outcome notes:
  • rebleeding : during admission
  • death : in hospital

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
rebleeding unknown 7
(17.1%)		 2
(4.65%)		 73%
(-24% to 94%)		 12.4%
(-0.70% to 25.6%)		 8
(NNT = 4 to infinity;
NNH = 140 to infinity)
rebleeding 12 months 14
(34.2%)		 5
(11.6%)		 66%
(14% to 87%)		 22.5%
(5.13% to 39.9%)		 4
(3 to 20)
death unknown 6
(14.6%)		 4
(9.30%)		 36%
(-109% to 81%)		 5.33%
(-8.54% to 19.2%)		 19
(NNT = 5 to infinity;
NNH = 12 to infinity)
death in first year. 12 months 9
(22.0%)		 6
(14.0%)		 36%
(-63% to 75%)		 8.0%
(-8.37% to 24.4%)		 13
(NNT = 4 to infinity;
NNH = 12 to infinity)
total mortality within 5 years weeks 18
(43.9%)		 14
(32.56%)		 26%
(-29% to 57%)		 11.34%
(-9.32% to 32.01%)		 9
(NNT = 3 to infinity;
NNH = 11 to infinity)

Comments

  1. Patients were allocated to either group based on the time of day they presented.

Citation

  1. Shemesh E, Czerniak A, Klein E, et al: A comparison between emergency and delayed endoscopic injection sclerotherapy of bleeding oesophageal varices in nonalcoholic portal hypertension. Journal of Clinical Gastroenterology 1990; 12 (1): 5-9
Contributor: Chris Ball and Musab Hayatli, October 1999
Reviewer:

Clinical Question.
Patient bleeding oesophageal varices
Intervention or Exposure early sclerotherapy
Comparison delayed sclerotherapy
Outcome rebleeding, death