J.Jpn. Surg. Soc.. 91(9): 1100-1103, 1990

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Report on the annual meeting

TREATMENT OF BLEEDING ESOPHAGOGASTRIC VARICES

Results of portal decompression shunts, non-shunting operations, and endoscopic sclerotherapy were reported. Portal decompression shunts were performed in 109 patients during the period 1949 to 1964 ; operative mortality was 17%, incidence of postoperative portal encephalopathy was 39%, and recurrence rate of bleeding was 25%. Long-term results in patients with extrahepatic portal obstruction were good but those in patients with idiopathic portal hypertension and liver cirrhosis were unsatisfactory. Non-shunting operations were performed in 532 patients. Overall operative mortality was 5.0%, but it was only observed in patients with cirrhosis. Longterm results with these procedures were satisfactory, cumulative survival rates at 10 years were 32.0% in patients with cirrhosis, and 77.6% with idiopathic portal hypertension and 90.7% with extrahepatic portal obstruction. Recurrent bleeding after operation was observed in approximately 20% of patients during the 10-year period after operation, but they were successfully treated by endoscopic sclerotherapy. Transection and devascularization procedures are safe and recommendable for patients in Child A and B categories, but are not indicated in Child C patients. Endoscopic sclerotherapy has been effective in recurrent or residual varices after surgery and as a prophylactic measure, but was not very effective in Child C patients or in large caliber varices.

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