J.Jpn. Surg. Soc.. 91(2): 234-245, 1990

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Original article

CLINICAL STUDY OF RADIOISOTOPIC SPLENOPORTOGRAPHY IN PORTAL HYPERTENSION

Radioisotopic splenoportography was performed in 55 patients with portal hypertension, in whom 52 had various degress of esophagogastric varices, and in 20 patients without portal hypertension.
In the patients with varices, collateral images were obtained in 50 patients (96%) by this method and no image was obtained in the patients without varices. The rate of positively imaged collaterals was as follows : Esophageal varices 69%, the left gastric vein 85%, the short gastric veins 48%, RI stasis in esophagogastric region 65%, the azygos vein 46%, the subclavian vein 25%, the para-umbilical veins 46%, splenoreal/gastrorenal shunts 19%, the inferior mesenteric vein 17%, the left intercostal veins 6%, and Arantius's duct 4%. These rates were superior to that obtained from the conventional transarterial portography. There were some corelations between RI-imjages by this method and clinical and laboratory findings ; patients with ascending collaterals alone tend ed to have extensive and severe varices and higher rate of bleeding, on the other hand, variceal bleeding was not found and episodes of portosystemic encephalopathy frequently occurred in patients with descending collaterals alones. After successful sclerotherapy, RI-images of esophageal varices disappeared in 92% of the patients.
Radioisotopic splenoportography appears to be a useful diagnostic and follow-up modality for patients with portal hypertension and esophagogastric varices.

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