Analysis of Long-Term Endoscopic Surveillance During Follow-up After Variceal Sclerotherapy From a 13-Year Experience

PURPOSE: To evaluate the course of patients with bleeding esophageal varices treated with endoscopic sclerotherapy after obliterating varices and to determine the cost benefits of long-term endoscopic surveillance from a retrospective analysis of a 13-year experience. LOCATION: University-affiliated teaching hospital and county facility. METHODS: Patients whose varices were obliterated by endoscopic sclerotherapy were considered for the study if they had a minimum of 12 months of follow-up. Sclerotherapy was initially performed weekly, increasing intervals to eventual yearly treatments. Varices were reobliterated if they reformed. Variables assessed were rebleeding, mortality, employment status, and cost based on allowable and reimbursed Medicare rates. RESULTS: Of 324 patients who achieved variceal obliteration, analysis included 104 eligible patients who were followed up for >12 months (41 ± 28). Varices reformed in 73 patients (71%), mostly in the first year after obliteration or reobliteration. Abstinent alcoholic patients were least likely to reform varices. Nineteen patients (18%) had 23 rebleeding episodes, and in 10 patients (10%) portalsystemic shunt was placed. Survival was 84% and bleeding-related mortality was 6%. Significantly more patients were employed while on the program compared with entry. The yearly cost of treating variceal reformers ($2,117) was significantly higher than variceal nonreformers ($1,735), but the overall cost of maintaining a patient on a chronic sclerotherapy program was relatively small. CONCLUSIONS: The low rebleeding, low mortality, and relatively low cost in patients managed long term by chronic sclerotherapy underscores the benefits of this treatment program.