Nonshunting Operations for Variceal Hemorrhage

Abstract

The treatment of bleeding esophageal varices has been undergoing change. Recently, endoscopic sclerotherapy has become almost universally accepted as the procedure of choice for acute bleeding episodes, but considerable disagreement exists over its ultimate value as long-term definitive therapy. During the past decade, there has also been a resurgence of interest in an effective nonshunting operation for control of variceal hemorrhage, both in urgent and elective situation. The introduction of reliable mechanical circular stapling instruments had simiplified the performance of esophageal transection for the treatment of both acute and chronic variceal hemorrhage. A nationwide survey on the treatment of esophageal varices was performed in 1990 jointly by the Japanese Research Society for Sclerotherapy of Esophageal Varices. The 5- and 10-year cumulative survival rates following sclerotherapy were, respectively, 55.57% and 41.58% in 7216 cases with liver cirrhosis (95%). Comparative assessment was done to evaluate the nonshunting treatment. The 5- and 10-year cumulative survival rates following esophageal transection and devascularization with splenectomy were, respectively, 64.95% (p<0.01) and 49.77% (p<0.01) in 4091 cases with liver cirrhosis (79%) and idoopathic portal hypertension (16%). Nonshunting operation is effective for improvement of cumulative survival ratres of patients with esophageal varices, and should be considered in the urgent management of acute failure of repeated sclerotherapy, it is a good long-term replacement for sclerotherapy, especially for the low-risk patient or those in Child's class A or B. © 1994, The Japanese Society of Gastroenterological Surgery. All rights reserved.