[Surgical measures in recurrent hemorrhage from esophageal and gastric varices after sclerotherapy--a prospective study].

Abstract

From Jan 1, 1982 to Jan 1, 1990 692 patients were admitted because of acute or recurrent hemorrhage from esophagogastric varices. Initial management was endoscopic sclerotherapy. 14 pat. were excluded. In 26 of 311 Child-Pugh C-patients a gastroesophageal disconnection and in 5 because of a portal pressure over 30 mmHg a narrow-lumen mesocaval interposition shunt (NLMCS) were performed because of uncontrollable hemorrhage. Hospital mortality was 31%. 182 pat. belonged to Child-Pugh class A and 185 to B. In 194 long-term injection sclerotherapy was successful; 173 were sclerotherapy failures and selected for shunt operation at the end of the selection analysis. 85 refused shunt operation or did not fulfill selection criteria. Thus, 88 pat. were shunted mainly by NLMCS and distal splenorenal shunt. Sclerotherapy and shunt group were comparable. Hospital mortality showed no difference. Five year life-expectancy was significantly higher in shunted patients. Thus, in sclerotherapy failures early a shunt-indication should be discussed.