Portal hypertension complicated by bleeding from esophageal and gastric varices: the present state of the problem of treatment and prevention

E.V. Mahiliavets, P.V. Harelik, V.I. Dubrovschik, V.M. Zhiber, A.P. Karpovich, E.N. Bozhko

Abstract


Background. Objective: to evaluate the effectiveness of comprehensive treatment and prevention of bleeding from esophageal and gastric varices in portal hypertension, including with the use of minimally invasive methods. Material and me­thods. The results of treatment were analyzed in 972 patients with portal hypertension who were treated in the HI “City Clinical Hospital 4 of Grodno” in the period from 2012 to 2016. Results. Endoscopic sclerotherapy of bleeding esophageal and gastric varices was successfully used in 67 patients with portal hypertension. Endoscopic ligation was performed in 12 patients. Sengstaken-Blakemore tube was used in 198 patients, while 22.7 % of them observed a relapse of bleeding after 12 hours. Endoscopic sclerotherapy for bleeding prevention was applied in 90 patients. Ten operations of azygoportal disconnection in the modification of Paciora were performed due to the ineffectiveness of other methods of hemostasis, 7 patients died. Seventeen operations of azygoportal disconnection in the modification of Sugiura-Futagawa and Hassab were carried out in 2012–2017, 1 patient died on the 11th day due to the progression of hepatic insufficiency. Sixteen operations of laparoscopic azygoportal disconnection, 15 transjugular intrahepatic portosystemic shunts were also performed. Thirty-day in-hospital mortality was not observed in these groups. Over 5 years, out of 277 patients with bleeding from esophageal and gastric varices, 121 died, lethality was 43.7 %. Among 695 patients with portal hypertension hospitalized in the department of gastroenterology, 11 died, lethality was 1.6 %, total lethality — 13.6 %. Conclusions. Methods of endoscopic sclerotherapy and ligation in the treatment and prevention of acute bleeding from esophageal varices are preferred. Traditional laparoscopic and X-ray endovascular surgical technologies are effective reserve methods for the treatment and prevention of bleedings from esophageal and gastric varices.


Keywords


esophageal and gastric varices; portal hypertension; treatment; endoscopic sclerotherapy; ligation

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DOI: https://doi.org/10.22141/1997-2938.1.36.2018.133005

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