Abstract

Until the last few years, the diagnosis of esophageal varices carried a prognosis worse than most other diseases, including coronary occlusion and cancer. The statistics vary but demonstrate similar results. Higgins (1) found that 84 per cent of those entering the hospital complaining of hematemesis died of hemorrhage. Blakemore (2) refers to the experience of Patek, who found that 50 per cent of his patients with Laennec's cirrhosis were dead within one year of the onset of their first hemorrhage. Palmer (3) quotes from Shull's experience: only 37 per cent of 180 cirrhotic patients were alive one year after the diagnosis of esophageal varices was made. The employment of the Sengstaken tube (4) and of relatively new surgical methods, especially the portacaval and splenorenal shunts, in the last few years, have offered hope of improving these statistics considerably, and prophylactic surgery for esophageal varices prior to hemorrhage is being seriously considered as the proper method of management. Therefore, the early diagnosis of esophageal varices has become much more important. Present Diagnostic Methods At the present time, only three acceptable antemortem methods of diagnosis are available: esophagoscopy, splenoportography, and roentgen study of the esophagus. Esophagoscopy offers the most accurate method of diagnosis, although occasionally a roentgen examination of the esophagus with the aid of barium has demonstrated varices which have been overlooked by the esophagoscopist (5). In spite of the fact that there is a morbidity rate (perforation of the esophagus, hemorrhage) of only 2 per cent or less and a mortality rate of 0.5 per cent or less associated with all esophagoscopy (5, 6), many physicians are reluctant to use the procedure in the presence of esophageal varices. In addition, about 8 per cent of patients refuse to undergo this examination (5). Percutaneous splenoportography as yet enjoys only a limited use in the United States, and no large series on the study of esophageal varices by this technic is available. At the present time, it appears to be a less accurate method than esophagoscopy and no more accurate than conventional x-ray examination of the esophagus (7). The advantages of roentgen examination of the esophagus are the absence of associated mortality or morbidity and ease of application. The disadvantage of this method is its low percentage of accuracy, though differences of opinion on this point are found among radiologists, who claim as little as 15 and as much as 50 per cent positive diagnoses in all cases of esophageal varices, both with and without a history of hematemesis (8, 9). A study of this type of examination was made by Brick and Palmer on the basis of a total of 172 patients examined in three separate university radiology departments under the direction of three different radiologists (10).

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