Study Objective: To define the roles of endoscopic variceal sclerosis and distal splenorenal shunt in the prevention of recurrent variceal bleeding in patients with cirrhosis.
Design: A prospective, randomized clinical trial with crossover for those failing therapy. The median follow-up was 61 months.
Setting: A private, tertiary-referral university hospital.
Patients: Seventy-two patients fulfilling inclusion criteria were drawn from a total of 420 patients treated during a 4.5-year interval.
Treatments: Endoscopic variceal sclerosis or distal splenorenal shunt.
Measurements And Main Results: Survival was significantly (P = 0.02) improved in patients randomly assigned to receive sclerotherapy: 13 of these 37 (35%) patients failed sclerotherapy and required surgical rescue. A survival advantage (P = 0.01) was seen in patients with alcoholic cirrhosis who had this combined therapy; however, in patients with nonalcoholic cirrhosis, survival for those receiving sclerotherapy and surgical rescue was not significantly (P = 0.36) different from that of patients receiving distal splenorenal shunt. Control of variceal bleeding was significantly (P less than 0.001) better in the distal splenorenal shunt group (34 of 35 [97%] compared with 15 of 37 [41%] in the sclerotherapy group). Using death, uncontrolled rebleeding, or shunt thrombosis as the endpoints resulted in no significant difference between treatment groups. Hepatocyte function and portal perfusion were significantly better maintained in patients with alcoholic cirrhosis who were managed by sclerotherapy rather than shunt (P = 0.01 and P = 0.001, respectively).
Conclusions: Endoscopic sclerotherapy with surgical rescue for uncontrolled bleeding is the optimum therapy for patients with alcoholic cirrhosis and variceal bleeding. Survival is similar in nonalcoholic patients treated with either distal splenorenal shunt or endoscopic sclerotherapy, but shunting provides better control of variceal bleeding.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.7326/0003-4819-112-4-262 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
The effectiveness of alternative vessel grafts for meso-rex bypass in the treatment of extrahepatic portal vein obstruction in children.
Pediatr Surg Int
December 2024
Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Purpose: This study aims to evaluate the effectiveness of alternative autologous vessel grafts in creating a Meso-Rex bypass (MRB) compared to the distal splenorenal shunt (DSRS) in resolving symptoms of portal hypertension in children.
Methods: All children with EHPVO evaluated for surgery at Siriraj Hospital from January 2011 to December 2023 were reviewed. Alternative autologous vessel grafts were used in all cases where MRB was feasible.
Postoperative intussusception following surgical repair of third-grade spleen rupture in a child: A unique case report.
Int J Surg Case Rep
November 2024
General Surgery Department, Hama National Hospital, Hama, Syria. Electronic address:
Introduction And Importance: Postoperative intussusception (POI) is a remarkably rare complication that may follow different types of operations. POI is responsible for 5-10 % of postoperative bowel obstruction. The main challenge in diagnosing this condition due to its nonspecific symptoms, which mimic post-op ileus.
View Article and Find Full Text PDFUse of Vascular Shunt at the Time of Pancreatectomy with Venous Resection: A Systematic Review.
Cancers (Basel)
June 2024
General Surgery Unit, Vito Fazzi Hospital, 73100 Lecce, Italy.
Background: The rising diffusion of vascular resections during complex pancreatectomy for malignancy, for both oncological and technical matters, brought with it the use of vascular shunts, either temporary or definitive, to prevent bowel congestion and liver ischemia. This study aimed to systematically review the literature on the technical feasibility of vascular shunts during advanced pancreatic surgery, analyzing intraoperative and postoperative outcomes.
Methods: A systematic literature search was performed on PubMed, Scopus, Web of Science, and the Cochrane Library Central, according to PRISMA guidelines.
multiple studies showed important benefices arising from splenic preservation in patients with digestive cancer in general and gastric cancer in particular. The minimally invasive approach remains controversial in locally advanced gastric cancer cases whilst the open approach still has an important role. This paper's aim is to describe and present the feasibility of an open surgical technique that allows removing stations 10 together with 11p and 11d with spleen and splenic vessels preservation in pacients operated upon by open surgery.
View Article and Find Full Text PDFDistal splenorenal shunt in an 8-year-old girl with rupture esophageal varices due to non-cirrhotic portal hypertension: A case report.
Int J Surg Case Rep
August 2024
Vascular and Endovascular Division, General Surgery Department, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Indonesia.
Introduction: Esophageal varices are dilated distal submucosal esophageal veins that connect the portal and systemic circulations. They are formed due to portal hypertension, which commonly resulted from cirrhosis. We presented an 8-year-old girl with esophageal varices without signs of cirrhosis.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!