Intensive care and minimally invasive procedures in complex treatment of bleedings from esophafeal varices in patients with decompensated liver cirrhosis

Abstract

From January 2004 to December 2010 in the clinic ofTranscarpathian Regional Clinical Hospital 64 patients with bleed-ing from esophageal varices with C-class liver cirrhosis by Child-Turcotte-Pugh criteria were examined and treated. The initial bleeding arrestin 39 (61%) patients was achieved with complex medical therapy and endoscopic sclerotherapy (ES). In 25 (39%) patients due to the inefficiency of the ES, authors used a Blakemore-Sengstaken tube. The III class of encephalopa-thy by West-Haven criteria was diagnosed in the in 37 (57.8%), in 27 it was of IV degree. In 3 (4.7%) patients ascites was transient and in 61 (95.3%) – refractory. In order to treat liver failure, as a major complication that caused bleeding adverse outcome in 27 patients with IV degree of encephalopathy authors used albuminperitoneal dialysis. Inorder to treat in-traabdominal hypertension at ascites in20 patients with III degree of hepatic encephalopathy authors applied laparocentesis with fluid evacuation. In17 patients they used extracorporeal ultrafiltration of asciticfluid with it’s subsequent intravenous reinfusion. In the subgroup of 39 patients with effective sclerotherapy the mortality rate was 23.1%. In the subgroup of 25 patients where the ES was ineffective and the Blackmore tube was applied, the mortality rate was 32%. Amongthe 20 pa-tients after laparocentesis with ascitic fluid evacuation 8 (40%) died. In the 17 patients after extracorporeal ultrafiltration of ascitic fluid with its subsequent intravenous reinfusion 2 (11.8%). In the subgroup where albumin peritoneal dialysis was applied 7 patients died (25.9%). A total of 17 (26.6%) patients died within the observation period of up to 5 days.