A Clinical Study on Portal Circulation of Esophageal Varices with Extraesophageal Gastrocaval Shunts

Fumio Chikamori, Hiroyuki Aoyagi, Niranjan Sharma*, Susumu Shibuya*, Kazuo Orii*, Yasuhiro Takase*

Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital
*Department of Surgery, Institute of Clinical Medicine, University of Tsukuba

Nineteen cases of esophageal varices with extraesophageal gastrocaval shunts were clinically studied to establish the importance of these shunts for injection sclerotherapy (IS). The results were compared with those of 24 cases of esophageal varices without shunts, in regard to portal venous pressure (PVP) and the rate of hematemesis. At the same time, the rate of embolization for variceal blood supply route and the shunts by IS was determined by comparing the percutaneous transhepatic portograms before and after IS. The PVP in patients with shunts was 335±60 mmH₂O and the rate of hematemesis in the same group was 26%, whereas the PVP in patients without shunts was 423±70 mmH₂O and the rate of hematemesis was 63%. These differences were statistically significant (p<0.01 and p<0.05 respectively). The rate of embolization for variceal blood supply route by IS in patients with shunts vs those without shounts was 88% vs 83% for the fundic venous plexus (NS), 1l% vs 67% for the left gastric vein (p<0.01), and 0% vs 25% for the short gastric vein (NS). The rate of embolization for the shunts was 11% for the gastroazygos/hemiazygos shunt, 0% for the gastrophrenic shunt and 0% for the gastrorenal shunt. We conclude that IS, for esophageal varices with extraesophageal gastrocaval shunts embolized the fundic venous plexus considerably, but it almost never embolizes the left gastric vein or the extraesophageal shunts which decompress the PVP.

Key words
injection sclerotherapy, extraesophageal gastrocaval shunt, esophageal varices

Reprint requests
Fumio Chikamori Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital
1-3-1 Amakubo, Tsukuba, 305 JAPAN

Accepted
September 9, 1992

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