LIMITATIONS OF NON-SHUNT OPERATIONS AND ENDOSCOPIC INJECTION SCLEROTHERAPY (EIS) FOR ESOPHAGEAL VARICES AND PLACES OF COMBINED TREATMENT

Abstract

Based on our clinical experience with 132 non-shunt operations and 80 EISs for esophageal varices due to liver cirrhosis, the significance of combined treatment of the both methods were studied referring the limitations of those two different kinds of treatment. Hospital mortality rates of the patients undergoing operation and EIS were 9.8% and 14%, respectively.In particular, limitations of clinical efficacy in both operation and EIS were revealed in patients belonging to Child's group C or receiving emergency treatment, since early and late operative results were extremely poor in those patients. Rebleeding from esophageal varices were seen in 7% of the operated patients and it was more frequent in patients who were not subjected to complete operations of transthoracic esophageal transetion and proximal gastric devascularization.Rebleeding rate was as high as 25% in patients undergoing EIS. Rebleeding was not seen in patients who received combined treatment; 8 underwent operation followed by EIS and 4 underwent EIS followed by operation. It can be said that, in order to avoid operative death, either esophageal transection or proximal gastric devascularization should be indicated in patients who have some risk factors for the complete operation, and EIS can be added if necessary. Operative treatment which has a long-term hemostatic efficiency for varices should be possibly added in patients whose hepatic function can be improved after EIS treatment.