Options for elective treatment of portal hypertension in cirrhotic patients in the transplantation era

Article Abstract:

Bleeding esophageal varices (enlarged, swollen and tortuous veins at the lower end of the esophagus) in patients with cirrhosis of the liver may be treated today with liver transplant. Other treatment options include both total and reduced-size portacaval shunt (surgical procedures which divert the blood supply away from the area of bleeding), and long-term endoscopic sclerotherapy (injection of a sclerosing, or hardening, agent directly into esophageal varices using an illuminated optic instrument to see into the esophagus). The relative benefits of these therapies are presented, as well as a plan of the options available to the cirrhotic patient. Only liver transplant treats both the cause of the varices, portal hypertension (increased pressure in the portal vein of the liver), and the underlying liver disease. All other modes of therapy available to cirrhotic patients are only palliative; long-term survival rates are a function of the progression of the liver disease. The authors report four-year-survival rates for cirrhotic patients with Class C (end-stage) liver disease to be 73 percent for those undergoing liver transplant, compared with 36 percent for those treated with shunt surgery and 59 percent for those treated by sclerotherapy. Liver transplant cannot be recommended for all cirrhotic patients with bleeding varices because of the large number of patients known to be unsuitable for transplant. It is recommended that the initial bleeding be stopped by endoscopic sclerotherapy, and then careful evaluation can be undertaken to determine the appropriate definitive elective treatment. Grade A patients seem to be managed best by reduced size portacaval shunt surgery. Grade B patients, (those with more severely damaged livers) may be treated by sclerotherapy, reduced size portacaval shunt surgery or liver transplant, depending on the individual case. Grade C patients do well with liver transplantation. For these end-stage patients, if transplant is not advisable, the next best option appears to be sclerotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Prognosis, Liver, Liver transplantation, Portal hypertension

---

Surgical procedures for bleeding esophagogastric varices when sclerotherapy fails: a prospective study

Article Abstract:

Esophageal varices result from portal hypertension (increased pressure in the portal vein of the liver). The most common cause of portal hypertension is liver cirrhosis (degenerative disease in which liver tissue is replaced by fibrous tissue and fatty deposits), which obstructs the flow of blood through the liver. The most efficient protection against repeated variceal bleeding is repeated injection sclerotherapy, in which a hardening agent is injected directly into the esophageal varices (enlarged veins at the lower end of the esophagus). However, rebleeding during treatment can occur in 23 to 55 percent of patients. A specific protocol is described for treatment of patients for whom sclerotherapy is not successful. The early and long-term results of this protocol are reported. Endoscopic sclerotherapy was used as initial treatment of 692 patients admitted to the hospital for bleeding esophageal varices with underlying liver cirrhosis. There were 367 patients with Class A or B liver cell failure; 194 were treated with long-term endoscopic sclerotherapy and 173 patients who had sclerotherapy failure (at least two rebleeding episodes) were considered for shunt surgery. There were 88 patients who met the criteria and had shunt surgery performed; 85 patients refused shunt and continued to be managed with endoscopic sclerotherapy (ES). At 30 days, there was no difference in mortality between the shunt and ES groups; late mortality was 36 percent in the shunt group and 17 percent in the ES group. It is concluded that when specific criteria are used to select Class A or B disease patients, the best form of treatment for bleeding esophagogastric varices resistant to ES treatment is shunt surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Surgery, Splenorenal shunt, Surgical, Surgical splenorenal shunt

---

Similar abstracts:

• Abstracts: A preliminary evaluation of 566C80 for the treatment of pneumocystis pneumonia in patients with the acquired immunodeficiency syndrome
• Abstracts: Ganciclovir for the treatment of cytomegalovirus gastroenteritis in bone marrow transplant patients: a randomized, placebo-controlled trial
• Abstracts: The value of noninvasive measurements in hypertension. Antihypertensive therapy: to stop or not to stop? Glomerular hyperfiltration indicates early target organ damage in essential hypertension
• Abstracts: Multidisciplinary treatment of primary orbital rhabdomyosarcoma: a single-institution experience. Ewing's sarcoma metastatic at diagnosis: results and comparisons of two intergroup Ewing's sarcoma studies
• Abstracts: Routine voluntary HIV screening in STD clinic clients: characterization of infected clients. Condom use to prevent incident STDs: the validity of self-reported condom use

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.