Abstract
To clarify the effects of prophylactic treatment for large gastric fundic varices, therapeutic efficacy, change in liver function and portal hemodynamics were studied in 27 patients who underwent Hassab's operation or balloon-occluded retrograde transvenous obliteration (B-RTO). Results are as following : 1) All gastric fundic varices were found to disappear by endoscopic examination, and they didn't recur throughout the period of observation ranging from 12 months to 126 months. 2) Refractory ascites was encountered in one of 8 patients who underwent Hassab's operation, but severe complications were not observed in 19 patients who underwent B-RTO. 3) Serum albumin level was significantly increased (p < 0.05) and ICGR, 5 value was significantly lowered (p < 0.05) one year after the treatment in patients whose portal flow was judged to be hepatofugal by superior mesenteric arterial venography before the treatment, and a diameter of gastric-renal shunt (GRS) or gastric-inferior phrenic vein shunt (GIS) were wider than 10 mm. 4) Cumulative detection rate of red color sign positive esophageal varices were significantly higher (p < 0.01) in patients with collaterals other than GRS or GIS before treatment (42.9% at before treatment, 84.1% at 4-years after) than that in patients without other collaterals (0% at 2-years, 16.7% at 4-years). We conclude that, by selecting appropriate cases, prophylactic treatment for large gastric fundic varices with Hassab's operation or B-RTO brings about beneficial results.
