Harold O. Conn

THE PROGNOSIS AND MANAGEMENT OF BLEEDING ESOPHAGEAL VARICES

One may summarize succinctly both the prognosis and the medical control of bleeding esophageal varices in a single nontechnical, nonmedical, but extremely descriptive word-lousy! Having stated my colloquial conclusion first I shall devote the remainder of this discussion to the state of the art of the management of bleeding esophageal varices and several of the major modes of therapy which together result in the awesome mortality associated with this disorder. FIGURE 1 shows the mortality associated with bleeding varices in the largest series of patients studied in this country over the past 25 years. They range from the 40% mortality of Ratnoff and Patek to 80% in Orloffs experience, and average 67% for the total of some 1100 patients,l-r i.e., only one out of every three patients with bleeding varices actually walks out of the hospital.