Recurrence and Remnants of Esophago-gastric Varices after Non-shunting Operation

Haruo Aoki, Akitake Hasumi, Yasuhiko Yoshimatsu, Koichi Hashimura, Tamotsu Ishida, Osamu Hayashi, Tomoyuki Kaneta, Yusuke Yasuda, Naohisa Oda

Department of Gastroenterological Surgery, Fujita Health University

The definition of post-operative recurrence and remnants of esophago-gastric varices after non-shunting operation for portal hypertension was studied, and the mechanisms and additional treatments were examined. In 72 cases of non-shunting operation (mucosa-preserving gastric transection), post-operative long-term variceal eradications were shown in 44 (61.1%). Varices greater than F₁ in grade in spite of postoperative transient variceal eradication recurred in 6 cases (8.3%). Varices greater than grade F₁ remaining after operation, i.e. remnants, occurred in 22 cases (30.6%). By postoperative angiogram, it was proved that recurrence and remnants of the varices were mainly caused by incomplete isolation of the proper esophageal arteries, rather than incomplete isolation or the recanalization of hepatofugal collateral flow from the portal vein. Therefore, based on knowledge of the mechanisms of recurrence and remnant existence, as non-surgical additional treatments for recurrent and remnant varices, trans-cathter arterial embolization (TAE) of the proper esophageal artery and endoscopic injection sclerotherapy (EIS) were concluded to be applicable.

Key words
recurrence of esophago-gastric varices, remnants of esophago-gastric varices, hemodynamics in recurrent and remnant varices, addtitional treatments for recurrent and remnant varices, trans-catheter arterial embolization of the proper esophageal artery

Reprint requests
Haruo Aoki Department of Gastroenterological Surgery, Fujita Health University
1-98 Dengakugakubo, Kutsukake-cho, Toyoake, 470-11 JAPAN

Accepted
October 11, 1990

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