Abstract
We currently study the vascular structure of portal system using angiography and endoscopic ultrasonography before the treatment of gastric varices. As the results of these studies, indication of nonsurgical treatment for gastric varices extended and most of patients are treated nonsurgically. We have retrospectively investigated the indication of surgical treatment for isolated gastric varices in five patients required surgical treatment. The pathogenesis of portal hypertension was idiopathic portal hypertension (IPH) in three, extrahepatic portal obstruction (EHO) in one, and liver cirrhosis (HCV-positive) with hepatocellular carcinoma in one. The indication for surgical treatment was necessity of splenectomy for IPH, repeated recurrence of gastric varices with IPH, IPH with peculiar vascular structure of the portal system, gastric varices with splenic varix in EHO, and hepatocellular carcinoma, each in one patient. Three patients with IPH and one patient with liver cirrhosis recovered satisfactorily. However, one patient with EHO had a recurrence of gastric varices three years after surgical treatment. Surgery for gastric varices should be considered in the following cases : 1) cases in which it is difficult to perform nonsurgical treatment due to a peculiar vascular structure of gastric varices and portal system, 2) cases of IPH that require splenectomy, and 3) cases in which surgery is needed to treat another disease coexisting with gastric varices (e.g., hepatocellular carcinoma or splenic varices).
