Abstract
To determine current role of surgery when endoscopic treatment of patients with esophagogastric varices is preferred, we retrospectively studied the clinical outcomes of patients who received endoscopic and/or surgical treatment. Between May/1982 and March/2000, we performed endoscopic treatment as the first choice in 288 patients with esophagogastric varices. Thirteen of the 288 (4.5%) had previously undergone varices-related surgery or required subsequent additional surgery. Upon review of the patients' medical records, nine patients (3.1%) were found to have undergone surgical treatment, such as esophageal transection or Hassab's operation, prior to endoscopic treatment. In contrast, only four (1.6%) patients required varices-related surgery after endoscopic treatment, including one for paraesophageal hematoma, and three for bleeding from gastric varices. Endoscopic treatment was ineffective in these latter three cases, which included a patient with left side portal hypertension who had required Hassab's operation. Nine patients died of variceal hemorrhage after endoscopic treatment who didn't surgery. Our findings show that endoscopic treatment alone effectively controlled esophagogastric varices in most patients (95.5%). However, intractable gastric varices should be treated by early surgery, and clinicians should be aware of the possible presence of local portal hypertension as it is a contra-indication for endoscopic treatment.
