We attempted to determine prognostic factors by comparison of cumulative survivals in each clinical factors in 605 patients with esophagogastric varices who underwent non-shunt operation such as esophageal transection and Hassab's operation. Univariate analysis revealed that sex, severity of liver function as assessed according to the Child's classification, timing of operation, postoperative bleeding and complicated hepatocellular carcinoma significantly influenced prognosis. By multivariate analysis, however, only severity of liver function and hepatocellular carcinoma were found to be significant independent prognostic factors. Therefore, postoperative bleeding is not a significant prognostic factor in non-shunt operation. The non-shunt operation may be superior to endoscopic treatment because bleeding from residual and recurrent varices, which often influences prognosis in endoscopic treatment, does not influence prognosis.

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Changes in portal hemodynamics after partial splenic embolization (PSE) was evaluated in patients with hypersplenism associated with portal hypertension. Thirty patients who underwent PSE were included. Volume of splenic infarction was calculated by summing width of infarcted area of the spleen in each plane of CT obtained after PSE, and the patients were divided into 2 groups with high infarction volume and low infarction volume. Portal and splenic venous blood flow were measured with pulsed Doppler ultrasonography. Esophagogastric varices were observed before and after PSE. Wedged hepatic venous pressure gradient was significantly decreased just after PSE. In patients with high pressure gradient before PSE and low infarction volume, however, the pressure gradient elevated again in 15 min. Although portal blood flow did not show significant change in both groups 1 year after PSE, splenic venous blood flow decreased significantly in the high infarction volume group. Esophageal varix was improved in 2 patients with infarction volume amounting to 79% and 70%. These results suggest that 1) Portal pressure decreases just after PSE, but in cases with severe portal hypertension and low infarction volume, compensatory mechanism works immediately after the procedure and elevates the pressure again, 2) Sufficient splenic infarction causes persistent decrease in splenic venous blood flow, and in some cases, causes decreased portal venous pressure and regresses esophageal varix.

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It is well known that the hepatic dysfunction and cirrhotic complications, such as esophageal varices and ascites, develop in alcoholic cirrhotic patients who continue to consume alcohol. In the present study, 16 male patients (mean age, 56.8 years), suffering from alcoholic liver cirrhosis with esophageal varices were enrolled. The patients were divided into drinking group (n=9) and abstinence group (n=7). To investigate effect of abstinence, we examined the period of abstinence, daily ethanol intake, the liver function and portal venous pressure (PVP) before variceal treatment. The abstinent periods were varied from 2 to 36 (mean 15.4) months. Serum levels of GOT, GPT and γ-GTP were significantly lower, and those of Alb and PT% were significantly higher in the abstinence group compared to the drinking group. PVP in abstinence group (19.0±7.4 mmHg), which included 3 patients with the pressure of less than 15 mmHg, was lower than that in the drinking group (26.0±2.6 mmHg). These results suggest that even as few as 1 year of abstinence can improve PVP and hepatic dysfunction and potentially reduce the recurrence of esophageal varices in patients with alcoholic liver cirrhosis.

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A long-term prognosis of 89 patients with esophagogastric varices followed up more than 10 years after treatment, and without hepatocellular carcinoma or any other malignant neoplasm were evaluated. Overall 10 and 20 year cumulative survival rates were 37.8% and 12.3% respectively. A short-term survival rate of surgery was lower compared with that of endoscopic treatment. Its 20 year cumulative survival rate was 18.9%, which was comparable to that of endoscopic treatment. The difference in survival rates was not revealed between esophageal transection and Hassab's operation. A 10 year cumulative survival rate of emergency cases was poor at 9.2%. Ten and 20 year survival rates of prophylactic cases were higher at 40.3% and 23.6% compared with those of the emergency cases at 9.2% and 0% respectively. Survival rate was related to Child-Pugh score grade; 51.9% in Child A, 27.1% in Child B and 9.1% in Child C. A 10 year cumulative survival rate of patients with recurrence of varices was 33.7%. There was no significant difference between patients with and without recurrence. It was suggested that appropriate treatments at the time of recurrence of esophagogastric varices may bring about a long-term favorable prognosis comparable to patients without recurrence.

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[in Japanese]

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[in Japanese]

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