A CLINICAL STUDY ON PORTAL CIRCULATION AND THE TREATMENT OF GASTRIC VARICES

Abstract

Thirty-eight patients with gastric varices undergoing percutaneous transhepatic portography (PTP) were divided into two groups, namely, 19 patients having a gastric varices in the cardia (Lg-c) and another 19 patients having a lesion in the fundus (Lg-f), to establish the treatment modality. The both groups were compared for portal venous pressure (PVP), incidence of chronic encephalopathy, main drainage route of gastric varices and effectiveness of injection sclerotherapy (IS). The PVP in patients with Lg-f was 269±49 mm H₂O and the incidence of encephalopahy was 32%, whereas in patients with Lg-c these figures were 384±36 mmHg₂O and 0% respectively. These differences were statistically significant (P<0.01 and p<0.05 respectively). The main variceal drainage routes in patients with Lg-f were gastro-renal shunt in 84% and gastro-pericaridophrenic shunt in 16%, whereas the main drainage route in all patients with Lg-c was esophageal varices. The eradication rate of gastric varices by IS using 5% ethanolamine oleate with iopamidol in patients with Lg-f and with Lg-c was 7% and 95% respectively (p<0.01).
The development of portosystemic shunt such as gastro-renal shunt or gastro-pericardiophrenic shunt was attributed to the lower PVP, higher incidence of encephalopathy and lower eradication rate by IS in patients with Lg-f. Therefore, it is thought that whereas the Lg-c can be treated by IS, the Lg-f should be treated by the method which can control the flow of the blood via these portosystemic shunt.