The Hemodynamics and the Treatment of Esophago-gastric Varices

Haruo Aoki

Department of Gastroenterological Surgery, Fujita Health University

The hemodynamics of portal area, particularly of the left gastric vein were studied by angiography in 84 patients with esophago-gastric varices. The cases in which the left gastric vein showed the reverse flow and as hepatofugal collaterales (Type I) were only 27 cases, while the cases in which the left gastric vein was not hepatofugal (Type II) were in majority. This type II includes two subtypes; to and fro type (Type IIa, 39 cases) and hepatopetal type (Type IIb, 18 cases). It was considered that esophago-gastric varices not only form due to hepatofugal collateral flow from portal area, but also due to elevation of venous pressure due to hyperdynamic state in local area of the lower esophagus and the upper part of stomach. The changes in micro-circulation in the gastoric wall in liver cirrhosis and the influence of estrogen on it examined clinically and experimentally. It was proved that the hyperdynamic state was caused by an increase in arterio-venous anastomoses in the submucosal layer of esophagus and stomach to which the arterial blood inflow through the left gastric artery, proper esophageal artery, etc., and the hyper-estrogenemia which occurred due to disturbance of liver function was one of the cause of the increase in submucosal arterio-venous anastomoses. It was concluded that the local hyaperdnamic state played the significant role in the formation of esophago-gastric varices in portal hypertension. Therefore, the interruption of the arterial inflow into the esophago-gastric area is important in the treatment of esophageal varices.

Key words
hyperdynamic state in portal area, hemodynamics of left gastric vein in portal hyperten-sion, arterio-venous anastmosis in submucosal layer of stomach, formation of esophago-gastric varices, arterial inflow into esophago-gastric varices

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

Accepted
June 5, 1991

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