Bleeding oesophageal and gastric varices: shunts

Abstract

Bleeding from oesophageal and/or gastric varices is responsible for more deaths than all other causes of gastrointestinal haemorrhage combined. Prospective studies have shown that once bleeding has occurred the patient is almost certain to bleed again and, ultimately, to die unless effective treatment is provided. Variceal bleeding is caused by portal venous hypertension. Clinically important portal hypertension exists when the difference between portal and inferior vena caval pressures (called the corrected portal pressure) exceeds 150 mm saline (11 mmHg). The elevated pressure in the portal venous system is almost always the result of obstruction to portal blood flow, usually within the liver (90–95% of patients), but occasionally at an extrahepatic site (5–10% of patients). The only definitive treatment of portal hypertension and bleeding from gastro-oesophageal varices is decompression of the portal system by a bypass shunt between the portal and systemic circulations.