Current strategy for esophageal varices in Japan

Article Abstract:

Esophageal varices (enlarged, swollen and tortuous veins at the lower end of the esophagus) and life-threatening variceal bleeding may be caused by portal hypertension, liver cirrhosis (degenerative disease in which liver tissue is replaced by fibrous tissue and fatty deposits), schistosomiasis (infection with a parasite transmitted to humans by water contaminated by feces), or hepatic (liver) obstruction. In Japan the most frequently used treatment modality for both emergency and elective cases of esophageal varices is sclerotherapy. Other methods of treatment include tamponade (use of pressure to stop bleeding); endoscopic sclerotherapy (injection of a sclerosing, or hardening, agent directly into esophageal varices using an illuminated optic instrument to see into the esophagus); devascularization (interruption of the circulation of blood to the bleeding point); and shunts (surgical procedures which divert the blood supply away from the area of bleeding). In Japan shunt operations are performed on 20 percent of cases of bleeding esophageal varices. Treatment of esophageal varices prophylactically (before bleeding occurs) is commonly performed in Japan. Factors that influence the decision regarding either surgery or sclerotherapy include: patient age less than 65 would favor surgery; elective treatment favors surgery, and emergency treatment, sclerotherapy; nature of the underlying liver disease; liver function and distribution of collateral vessels. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Japan, Surgery

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Selective variceal decompression and its role relative to other therapies

Article Abstract:

Esophageal varices are a complication of 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. Results of 10 years of experience using DSRS are reported. Seventy patients with portal hypertension complicated by bleeding esophageal varices underwent distal splenorenal shunt (DSRS) surgery, with and without disconnection of the spleen from the pancreas. The cause of portal hypertension in 57 percent of patients was alcoholic liver cirrhosis. Seven of these patients had thrombosis of the portal vein; the remaining patients had some form of liver cirrhosis. The mortality for surgery was 13 percent. Encephalopathy (abnormal brain function) was noted by clinical symptoms in 7 percent of patients, but electroencephalogram identified encephalopathy in 24.6 percent of patients. Development of encephalopathy was associated with decreased blood flow through the portal vein to the liver, active hepatitis (liver infection) and incomplete splenopancreatic disconnection (SPD). An effective SPD appears to minimize the negative effects of portal perfusion and allows a better quality of life for the patient. Results of this 10-year analysis indicate that DSRS is an extremely effective therapy to prevent rebleeding from esophageal varices. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Splenorenal shunt, Surgical, Surgical splenorenal shunt

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