A long-term follow-up of portal hemodynamics was made during a period of 3.6 ± 3.3 years in 95 patients who underwent endoscopic treatment for esophageal varices using digital subtraction angiography.
The study concluded that (1) The recurrence rate of esophageal varices in patients with extravariceal collaterals before endoscopic treatment tended to be lower than that in patients without collaterals (p = 0.23). In contrast, formation of new extravericeal collaterals after endoscopic treatment didn't have any influences on the reduction of the recurrence rate of esophageal varices. (2) The incidence of complete obstruction of left gastric vein confirmed by angiography was 0 % in patients whose direction of left gastric vein before endoscopic treatment was hepatofugal or undetermined. While the incidence was approximately 20 % in patients whose direction of LGV before endoscopic treatment was hepatopetal or to-and-fro. (3) The blood flow of left gastric vein was hepatofugal or undetermined in approximately half of the patients with recurrent esophageal varices, and, it was hepatopetal or to-and-fro in the remaining patients.
These results suggest that the presence of collaterals and the direction of left gastric vein independently affect the recurrence of esophageal varices.

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Hassab's operation, the transabdominal decongestion with splenectomy originated by Hassab was one time prevailing for the treatment of bleeding esophago-gastric varices. The operation is, however, hardly curative because it doesn't obliterate intramural blood flow of the esophagus.
Nowadays more curative and less laborious endoscopic treatment such as endoscopic ingestion sclerotherapy (EIS) and endoscopic variceal ligation (EVL) and radiological interventions such as transjuglar intrahepatic portal systemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) are regarded as the treatment of choice for esophageal varices. However, when these treatment fails, or varices are accompanied by severe hypersplenism, Hassab's operation incombination with the endoscopic treatment is still selected.
We evaluated the effect of the combination treatment in 10 patients with esophageal and/or gastric varices during the period of 1967-2004 with a group of 32 patients with varices who underwent only Hassab's treatment as a control.
During the period of a 15 year follow-up, no patients with esophageal varices who received the combination treatment bled, while 24% of patients who underwent only Hassab's operation bled. On the other hand no patient with gastric varices who underwent only Hassab's operation bled.
From these observations it is suggested that the combination treatment, Hassab's operation with EIS or EVL, is recommended for patients with esophageal varices, while uncombined Hassab's operation is recommended for those with gastric varices.

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[in Japanese]

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[in Japanese]

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