ABSTRACT
BACKGROUND/AIMS: The pathophysiology of gastric varices may be due to generalized or segmental portal hypertension. A considerable debate has arisen regarding the role of injection sclerotherapy in the pathogenesis of gastric varices. METHODOLOGY: During the period from 1987 to 1997, a total of 1686 cases with bleeding varices were presented to our center and 225 cases (13.3%) with bleeding gastric varices were diagnosed. There were 198 males and 27 females with a total mean age of 45.7 years (+/- 7.6). Primary fundal varices (FV) were found in 121 (54%) cases and secondary FV were found in 104 (46%) cases. All patients with isolated FV presented with repeated attacks of upper gastrointestinal bleeding. RESULTS: The pathological diagnosis was studied in 120 cases; it was schistosomal in 8.3% of cases, non-schistosomal in 33.3% of cases, and mixed (Schistosomal with post viral cirrhosis) in 58.3% of cases. Seventy-five cases were subjected to splenectomy and gastroesophageal decongestion (SGED), 64 cases were subjected to distal splenorenal shunt (DSRS), and 86 cases were subjected to sclerotherapy. Mortality after DSRS was 7.8%, after SGED it was 12%, and after sclerotherapy it was 21%. Rebleeding was the major complication and occurred in 3% after DSRS, in 13% after SGED, and in 18% of cases after sclerotherapy. CONCLUSIONS: Gastric varices are not an uncommon condition as a cause of upper gastrointestinal bleeding. Our findings support the hypothesis that gastric varices may be considered a late sequel of injection sclerotherapy, though they may also be considered as one of the pathophysiologies of generalized portal hypertension. Finally, DSRS was found to be the treatment of choice in the management of fundal varices.
Subject(s)
Esophageal and Gastric Varices/surgery , Gastrointestinal Hemorrhage/surgery , Adult , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/physiopathology , Female , Follow-Up Studies , Gastric Fundus/blood supply , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/physiopathology , Humans , Hypertension, Portal/complications , Male , Middle Aged , Postoperative Complications/mortality , Recurrence , Sclerotherapy , Splenectomy , Splenorenal Shunt, Surgical , Survival RateABSTRACT
BACKGROUND/AIMS: The present study was designed to evaluate the treatment of malignant dysphagia by laser palliation. METHODOLOGY: Between November 1994 and May 1997, 104 patients with esophageal carcinoma were subjected to endoscopic palliation with Nd-YAG laser. They were 83 men and 21 women with mean age 57+ 6.32 years. The majority of cases (94%) presented with difficulty in swallowing. Patients were treated at one-week intervals until benefit was achieved. RESULTS: A tumor mass was observed in the lower third of the esophagus in 75 (72%) patients. The tumor mean length was 6 cm (range 3-10 cm). Histology revealed that 74 (71%) patients had squamous cell carcinoma and 30 (29%) patients had adenocarcinoma. Hospital mortality occurred in 6 (5.76%) cases because of esophageal perforation, fistula, or pyothorax, and late mortality occurred in 29 (27.9%) patients. Perforation occurred in 5 (4.8%). Improvement in dysphagia occurred after a mean of 3.3 (range 1-13) treatment sessions. Luminal patency allowing easy passing of the endoscope was achieved in 59 (93%) patients. Relief of symptoms and overall outcome improvement occurred in these patients in a relatively short time, there was body weight gain and an increase in serum albumin levels in 65% of patients. CONCLUSION: In conclusion, control of dysphagia by laser palliation suggests that endoscopic laser therapy should not be regarded as being in competition with other treatment techniques such as surgery, radiation, chemotherapy, dilatation or stents, in contrast it plays a complementary role to these palliative modalities.
