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Transjugular Intrahepatic Portosystemic Shunt or Sclerotherapy: Which Would You Choose?
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
We read with interest the editorial by Dr. Conn [1] discussing two randomized, controlled trials that compared endoscopic sclerotherapy with transjugular intrahepatic portosystemic shunts (TIPS) for the treatment of patients who survived hemorrhage from esophageal varices. We take exception to two of Dr. Conn's opinions.
First, Dr. Conn states that endoscopic sclerotherapy “… is widely held to be the standard therapy for bleeding varices.” This may have been true until several years ago, but most authorities would argue that endoscopic sclerotherapy has been largely supplanted by endoscopic ligation therapy, particularly now that reliable multiple band ligating devices are commercially available and make an overtube unnecessary. Compared with sclerotherapy, ligation therapy requires fewer treatment sessions, is associated with fewer complications, and may result in lower rates of rebleeding and death [2-4]. These important factors are not adequately addressed by Dr. Conn.
Second, we are bothered by Dr. Conn's comments about how he would want to be managed if he had variceal bleeding. Although he would like to be enrolled in a clinical trial comparing sclerotherapy and TIPS, he says that he would refuse participation if randomly assigned to endoscopic treatment. Why, as a leading figure in the field, would he design this trial for others but not participate fully himself? And if he feels strongly that pharmacotherapy should be an option, why was it not included in his hypothetical study? Thought leaders in medicine should not be so glib about patient care.
John B. Marshall, MD
Paul D. King, MD
University of Missouri-Columbia; Columbia, MO 65212
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
