Portal fibrosis and schistosomal portal hypertension: what is the best strategy for primary and secondary prevention of hemorrhage from esophageal varices

Variceal bleeding: consensus meeting report from the Brazilian Society of Hepatology

“…It has the propensity to worsen esophageal varices and as previously mentioned can be applied only to those subjects with concurrent gastrorenal shunts (61,109) . (15) . It is estimated that 8%-15% of the patients with cirrhosis can develop EHPVO even in the absence of hepatocellular carcinoma (3,59) .…”

“…Data concerning the management of PH due to schistosomiasis are either scarce or uncontrolled and mainly based on experts opinion (15,123) . As a matter of fact, for primary prophylaxis and control of the acute bleeding episode, treatment options do not differ from those employed in cirrhosis (15) .…”

“…As a matter of fact, for primary prophylaxis and control of the acute bleeding episode, treatment options do not differ from those employed in cirrhosis (15) . For secondary prophylaxis, there are controlled data indicating that azigos portal disconnection is the best surgical treatment (119) , but there are no RCT comparing surgery to EBL or NSBB (15) .…”

“…As a matter of fact, for primary prophylaxis and control of the acute bleeding episode, treatment options do not differ from those employed in cirrhosis (15) . For secondary prophylaxis, there are controlled data indicating that azigos portal disconnection is the best surgical treatment (119) , but there are no RCT comparing surgery to EBL or NSBB (15) . Short-term hemodynamic studies have suggested that high doses of NSBB are required to lower portal pressure in patients with PH due to schistosomiasis (101) , but these findings were not reproduced in another study that measured variceal pressure in subjects with PH due to schistosomiasis (55) .…”

Resultados a longo prazo da desconexão ázigo-portal e esplenectomia em portadores de esquistossomose hepato-esplênica: avaliação clínica, laboratorial, endoscópica e ultra-sonográfica com tempo de seguimento mínimo de 5 anos

“…Diante da baixa eficácia do tratamento clínico e endoscópico, a grande maioria dos Serviços que lidam com estes pacientes adota o tratamento cirúrgico para evitar a recidiva hemorrágica (Abrantes, 1986;Ezzat et al, 1986;Leonardi et al, 1988;D'Albuquerque et al, 1990;Boin, 1991;de Capua Junior e Szutan, 1991;Raia et al, 1991;Kelner, 1992;da Silva, 1992;da Silva e Carrilho,1992;Lacerda et al, 1993;Szutan, 1993;Lopes Filho, 1994;Raia et al, 1994;Pugliese, 1996;Hassab, 1998;Ferraz et al, 2001a e b;Santos, 2002;Assef et al, 2003;Bittencourt, 2003;Petroianu, 2003;Laosebikan et al, 2005).…”