Comparative Study of Shunt Surgery and Endoscopic Injection Sclerotherapy for Esophageal Varies

Soichiro Kanaya¹⁾²⁾, Hiroyuki Katoh¹⁾, Kimihiro Nakajima¹⁾, Shunichi Okushiba¹⁾, Eiji Simozawa¹⁾, Tatsuzo Tanabe¹⁾, Takahiro Sato²⁾, Toshihiro Suga²⁾, Yoshio Murashima²⁾

¹⁾The Second Department of Surgery, Hokkaido University School of Medicine
²⁾Department of Gastroenterology, Sapporo Kosei Hospital

Late results of treatment of esophageal varices were comparatively evaluated in 84 cases of endoscopic injection sclerotherapy (EIS) and 49 cases of shunt surgery for Child A and B patients. Recurrent and rehemorrhagic rates in the EIS group were 21.7 and 13.3%, respectively. The corresponding values in the shunt surgery group were 2.1 and 2.1%, respectively. The results indicated high incidence rates in the EIS group for both parameters. The cumulative five year survival rates in the EIS and shunt surgery groups were satisfactory, and 82 and 88%, respectively, with no significant difference between the two groups. The rehabilitation rates in the late period in the EIS and shunt surgery groups were 81.2 and 74.2%, respectively, with satisfactory results in both groups. In the EIS group, however, patients with four or more EIS in the initial hospitalization showed a lower complete disappearance rate than those with three or fewer EIS, and had significantly higher recurrence and re-hemorrhagic rates and longer hospital stays than the others. Thus early surgical intervention is recommended. Shunt surgery can be performed safely and with low recurrence and re-hemorrhagic rates even after EIS treatment and the recurrence and re-hemorrhagic rates are low. Aggressive shunt surgery is believed to be indicated.

Key words
esophageal varices, shunt sergery, endoscopic injection sclerotherapy

Reprint requests
Soichiro Kanaya The Second Department of Surgery, Hokkaido University School of Medicine
Kita 15 Nishi 7, Kita-ku, Sapporo, 060 JAPAN

Accepted
April 14, 1993

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