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Vasopressin+nitroglycerin infusion Vs balloon tamponade in the treatment of acute bleeding from gastro-oesophageal varices. A randomized controlled trial
157
VASOPRESSIN+NITROGLYCERININFUSION Vs BALLOON TAMPONADE IN THE TREATMENTOF ACUTE BLEFDING FROMGASTRO-OESOPHAGEALVARICES. A RANDOMIZED CONTROLLEDTRIAL. J.Ter~s, R. Planas, J.Pan~s, JM. Salmer6n, F.Feu, C.Llorente, J.Viver, J.Bosch, J.Rod~s. Liver Unit, Hospital C l i n i c i Pr o v inc ia l, Barcelona. Digestive Service, Hospital G. Trias i Pujol, Badalona. Digestive Service, Hospital Mutua de Terrassa. Vasopressin infusion and oesophageal tamponade have been widely used f o r many years to arrest variceal bleeding, but there is no objective evidence on the s u p e r i o r i t y of any of these two procedures. In the present study, 103 consecutive c i r r h o t i c patients a c t i v e l y bleeding from varices were included in a prospective randomized t r i a l aimed to investigate the comparative e f f i c a c y and safety of balloon tamponade (n=50)(using the Sengstaken tube for oesophageal varices and the Linton tube f or gastric varices) and i . v . vasopressin infusion (0.4 - 0.8 u/m) plus i . v . n i t r o g l y c e r i n infusion (40 - 400 ug/m)(n=53). Both treatments were maintained for a 24 h. period. Randomization was s t r a t i f i e d for location of the bleeding v a r i x (oesophageal or g a s t r i c ) and severity of l i v e r f a i l u r e . Both therapeutic groups were also s i m i l a r in age, sex and severity of bleeding. Failure of treatment was defined as f a i l u r e to arrest bleeding and/or any subsequent bleeding during the 24h period of treatment. Results: Tamponade Dru_~ £ A-Failure to arrest bleeding 4/50 11/53 NS. B-Rebleeding during treatment 2/46 10/42 .005 C-Failure of treatment (A+B) 6/50 21/53 .02 No s i g n i f i c a n t differences were found in respect to rebleeding during the f i r s t 72h a f t e r treatment ( T : I 2 / 4 4 ; D : I I / 3 2 ) , m o r t a l i t y rate ( T : I 2 / 5 0 ; D : I I / 5 3 ) , severe complications (one in each group), side effects requiring withdrawal of therapy (T:3, D:4) and minor side effects. Conclusion: Oesophageal tamponade is more e f f e c t i v e than vasopressin+nitroglycerin i n f , sion in the treatment of active variceal bleeding in c i r r h o t i c patients.
158
LONG-TERM FOLLOW-UP OF POST-TRANSFUSION (PT) NANB HEPATITIS F. Tremolada~ C. Casarin~ L. B e n v e g n ~ C. DraKo ~ A. Alberti and G. Realdi _Ist~ tuto di Medicina Clinica, Universit~ di Padova (Italy).
Although chronic PT nAnB hepatitis is generally a clinically benign disease, there is accu mulating evidence that some cases progress to severe liver disease. However the ultimate pr9 gnosis has not yet been established in long-term follow-up studies. In a prospective study we have followed for at least 12 months 135 patients with acute PT hepatitis. Thirty-four (25%) resolved their hepatitis within one year, 101 (75%) progressed 6o chronic liver phase with only mild symptoms in 25%. Of these latter, 54 were followed for 74+16 months and were submitted to at least one liver biopsy after 23+16 months from acute onset. Follow-up biopsi es were obtained in 21 patients, 12-90 months after the first histology. On initial liver bi opsy, i0 patients had chronic persistent hepatitis (CPH), 4 chronic lobular hepatitis (CLH)~ 34 chronic active hepatitis (CAH) and 6 liver cirrhosis. Of the 21 patients rebiopsed, evidence of histologic progression to cirrhosis was obtained in 12 cases. Thus overall 18 of 54 biopsied patients (33%) had signs of cirrhotic transformation. Eight of these died during follow-up, one for hepatocellular carcinoma (HCC) developed 9 years after acute onset, three for oesophageal hemorrhage and the remaining four for complications of their underling disea se. In 7 patients histology remained unchanged while 2 improved from CAH to CPH. A prolonged normalization of transaminase for more than 6 months was documented in 9 patients (16.6%), 7 of whom with persistent activity at liver biopsy. Our data show that chronic nAnB PT hepatit is, although silent, progress to cirrhosis in a high percentage of cases and also to HCC and that only histologic evaluation can really document the state of the disease.
$81
VASOPRESSIN+NITROGLYCERININFUSION Vs BALLOON TAMPONADE IN THE TREATMENTOF ACUTE BLEFDING FROMGASTRO-OESOPHAGEALVARICES. A RANDOMIZED CONTROLLEDTRIAL. J.Ter~s, R. Planas, J.Pan~s, JM. Salmer6n, F.Feu, C.Llorente, J.Viver, J.Bosch, J.Rod~s. Liver Unit, Hospital C l i n i c i Pr o v inc ia l, Barcelona. Digestive Service, Hospital G. Trias i Pujol, Badalona. Digestive Service, Hospital Mutua de Terrassa. Vasopressin infusion and oesophageal tamponade have been widely used f o r many years to arrest variceal bleeding, but there is no objective evidence on the s u p e r i o r i t y of any of these two procedures. In the present study, 103 consecutive c i r r h o t i c patients a c t i v e l y bleeding from varices were included in a prospective randomized t r i a l aimed to investigate the comparative e f f i c a c y and safety of balloon tamponade (n=50)(using the Sengstaken tube for oesophageal varices and the Linton tube f or gastric varices) and i . v . vasopressin infusion (0.4 - 0.8 u/m) plus i . v . n i t r o g l y c e r i n infusion (40 - 400 ug/m)(n=53). Both treatments were maintained for a 24 h. period. Randomization was s t r a t i f i e d for location of the bleeding v a r i x (oesophageal or g a s t r i c ) and severity of l i v e r f a i l u r e . Both therapeutic groups were also s i m i l a r in age, sex and severity of bleeding. Failure of treatment was defined as f a i l u r e to arrest bleeding and/or any subsequent bleeding during the 24h period of treatment. Results: Tamponade Dru_~ £ A-Failure to arrest bleeding 4/50 11/53 NS. B-Rebleeding during treatment 2/46 10/42 .005 C-Failure of treatment (A+B) 6/50 21/53 .02 No s i g n i f i c a n t differences were found in respect to rebleeding during the f i r s t 72h a f t e r treatment ( T : I 2 / 4 4 ; D : I I / 3 2 ) , m o r t a l i t y rate ( T : I 2 / 5 0 ; D : I I / 5 3 ) , severe complications (one in each group), side effects requiring withdrawal of therapy (T:3, D:4) and minor side effects. Conclusion: Oesophageal tamponade is more e f f e c t i v e than vasopressin+nitroglycerin i n f , sion in the treatment of active variceal bleeding in c i r r h o t i c patients.
158
LONG-TERM FOLLOW-UP OF POST-TRANSFUSION (PT) NANB HEPATITIS F. Tremolada~ C. Casarin~ L. B e n v e g n ~ C. DraKo ~ A. Alberti and G. Realdi _Ist~ tuto di Medicina Clinica, Universit~ di Padova (Italy).
Although chronic PT nAnB hepatitis is generally a clinically benign disease, there is accu mulating evidence that some cases progress to severe liver disease. However the ultimate pr9 gnosis has not yet been established in long-term follow-up studies. In a prospective study we have followed for at least 12 months 135 patients with acute PT hepatitis. Thirty-four (25%) resolved their hepatitis within one year, 101 (75%) progressed 6o chronic liver phase with only mild symptoms in 25%. Of these latter, 54 were followed for 74+16 months and were submitted to at least one liver biopsy after 23+16 months from acute onset. Follow-up biopsi es were obtained in 21 patients, 12-90 months after the first histology. On initial liver bi opsy, i0 patients had chronic persistent hepatitis (CPH), 4 chronic lobular hepatitis (CLH)~ 34 chronic active hepatitis (CAH) and 6 liver cirrhosis. Of the 21 patients rebiopsed, evidence of histologic progression to cirrhosis was obtained in 12 cases. Thus overall 18 of 54 biopsied patients (33%) had signs of cirrhotic transformation. Eight of these died during follow-up, one for hepatocellular carcinoma (HCC) developed 9 years after acute onset, three for oesophageal hemorrhage and the remaining four for complications of their underling disea se. In 7 patients histology remained unchanged while 2 improved from CAH to CPH. A prolonged normalization of transaminase for more than 6 months was documented in 9 patients (16.6%), 7 of whom with persistent activity at liver biopsy. Our data show that chronic nAnB PT hepatit is, although silent, progress to cirrhosis in a high percentage of cases and also to HCC and that only histologic evaluation can really document the state of the disease.
$81