Treatment of bleeding esophageal varices in portal-systemic shunt failures.

Abstract

In some patients with massive hemorrhage from esophageal varices, and particularly in extrahepatic portal obstruction, shunting procedures fail to prevent further significant bleeding or are technically impossible. For this relatively small group of patients with portal hypertension, a variety of approaches have been proposed, including varix ligation,¹hepatic or splenic arterial ligation,²injection of sclerosing agents,³omentopexy,⁴mediastinal packing,⁵gastric and esophageal transection and resuture,^6-8and gastric and esophageal resection. These latter operations have been designed either to excise the acid-secreting portions of the stomach and thereby prevent acidpeptic erosion of the mucosal covering of the varices, or to excise the varix tissue itself. The introduction of procedures involving excision of the stomach and esophagus occurred during the same years that the potral-systemic shunt procedures were first clinically introduced on a broad scale (Table 1).^9-14However, the number of patients subjected to such