Cost-effectiveness Analysis of the Treatment of Esophageal Variceal Bleeding: Modified Sugiura Procedure vs. Endoscopic Therapy

Bae, Byung Noe; Yang, Keun Ho; Kim, Hong Yong; Kim, Ki Hwan; Han, Se Hwan; Kim, Hong Joo; Kim, Young Duck; Shin, Won Chang

Abstract

BACKGROUND/AIMS: According to current studies, the patients treated with modified Sugiura procedure show lower rebleeding rates compared with endoscopic therapy. The aim of this case-control study was to compare modified Sugiura procedure (transabdominal esophageal transection plus esophagogastric devascularization plus splenectomy) with endoscopic therapy for the prevention of recurrent variceal bleeding. METHODS: Twenty patients were treated with surgery and 22 patients were treated with endoscopic therapy. We compared their outcomes. Measured main outcomes were mortality, variceal rebleeding, post-interventional changes of liver function, total hospital days, and total hospital charges. RESULTS: Overall mortality in this series was not different. Bleeding related mortality and encephalopathy in the endoscopic therapy group were slightly higher than those in the surgery therapy group. However, these differences were not statistically significant. In patients treated with the modified Sugiura procedure, the liver function was remarkably improved after the operation. Rates of rebleeding (p<0.001), requiring additional endoscopy (p=0.016) and rehospitlalizations (p=0.008) were higher in endoscopic therapy group. In spite of initial lower cost, the overall costs of endoscopic therapy were higher than those of surgery if the costs for the prevention of variceal rebleeding was included. CONCLUSIONS: These results indicate that modified Sugiura procedure for esophageal variceal bleeding could improve therapeutic efficiency and quality of life of the patient, especially in the patients with good liver reservoir function.