Splenectomy and ligation of the left gastric vein in schistosomiasis mansoni: The effect on esophageal variceal pressure measured by a non-invasive technique

Abstract

The treatment of choice, in the Northeast of Brazil, of patients with a history of upper GI bleeding from ruptured esophageal varices (EV) and with hepatosplenomegaly secondary to schistosomiasis (HSS), is splenectomy and left gastric vein ligation (SLGL). However, the effect of this procedure on the EV pressure, the parameter that best correlates to re-bleeding risk, has not yet been evaluated. With the introduction of a minimally invasive technique to measure the EV pressure, it has become possible to assess the effect of this surgery without an increased risk to the patient. SLGL was performed in twenty two patients with a history of HSS and upper GI Bleeding secondary to esophageal varices. The non-invasive endoscopic pneumatic balloon was used to measure the EV pressure before surgery and the results were then compared with measurements made between five and eight days post-operatively. The pre-operative EV pressure ranged from 20.0 mmHg to 28.7 mmHg (mean 24.35 +/- 2.36 mmHg), with no correlation between the pressure and the calibre of the varices. In the post-operative period, a significant decrease in EV pressure was observed, ranging from 14.6 mmHg to 21.5 mmHg (mean 17.29 +/- 1.75 mmHg, p < 0.001). These results support the use of SLGL in patients with HSS and a history of variceal bleeding. The operation results in, at least for the short term and in the majority of cases, a reduction in the EV pressure, and therefore a reduced risk of repeating upper GI Bleeding.