Distal spleno-renal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding

Spina, G. P.; Henderson, J. Michael; Rikkers, Layton F.; Terés, Josep; Burroughs, Andrew K.; Conn, Harold O.; Pagliaro, Luigi; Santambrogio, Roberto; Ascione, Antonio; Bordas, Josep M.; Brooks, William S.; Buchi, Kenneth M.; Burnett, David; Cormier, Robert A.; Galambos, John T.; Kutner, Michael; Millikan, William J.; Opocher, Enrico; Pisani, Andrea; Riepe, Stanley P.; Visa, Josep; Wd, Warren

doi:10.1016/s0168-8278(05)80666-x

Cited by 73 publications

(28 citation statements)

References 34 publications

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“…It has become clear that selective shunts lose their selectivity with time, leading to a decline in portal flow toward the liver and thus the inherent risks for hepatic encephalopathy and declining liver function. 21,22 In our series, prograde portal flow was maintained, and there were no treatment failures beyond 3 months after the SDPHG shunt procedure.…”

Section: Discussionmentioning

confidence: 51%

Small-Diameter Portacaval H-Graft Shunt: A Paradigm Shift Back to Surgical Shunting in the Management of Variceal Bleeding in Patients With Preserved Liver Function

Hillebrand

2000

Liver Transplantation

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Section: Discussionmentioning

confidence: 51%

Small-Diameter Portacaval H-Graft Shunt: A Paradigm Shift Back to Surgical Shunting in the Management of Variceal Bleeding in Patients With Preserved Liver Function

Hillebrand

2000

Liver Transplantation

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“…Furthermore, the DSRS improved 5-year survival rate from 80% to 90% particularly in the setting of presinusoidal portal hypertension with adequate liver reserve (Child class A and B) [139][140][141][142] . This surgical procedure remains a good option for:…”

Section: Distal Splenorenal Shunt (Warren's Shunt)mentioning

confidence: 96%

“…The postoperative DSRS encephalopathy rate is 5%-19% . Spina et al [141] has been compared the Warren shunt with endoscopic sclerotherapy and showed the Warren shunt improve survival and reduced rebleeding risk without worsening encephalopathy.…”

Section: Outcomes Of Warren's Shuntmentioning

confidence: 99%

Surgical outcomes of distal splenorenal shunt or liver transplantation in treatment of schistosomal refractory variceal bleeding

Doush¹,

Elzein²

2018

JUMD

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Schistosomiasis is one of the most prevalent neglected tropical diseases, remains a serious public health problem in many developing countries in the tropics and subtropics and its pathogenesis depends on the parasite-host interaction. Periportal fibrosis of schistosomiasis complicated by portal hypertension results from increased intrahepatic vascular resistance and blood flow through the portal venous system. This leads to portosystemic collateral variceal veins formation which dilates until they finally rupture and bleed due to progressive rising in the portal venous pressure. The clinical impact of esophagogastric varices is critical due to the rebleeding rate of esophageal varices remains high within two years after cessation of acute bleeding from medium or large varices. In the present review, we will discuss hepatosplenic schistosomiasis and oesophagogastric varices pathophysiology and review the current surgical outcomes of distal splenorenal shunt or liver transplantation in schistosomal refractory variceal bleeding.

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“…Shunt procedures Portocaval or distal splenorenal shunts have been used in preventing recurrent variceal bleeding. A meta-analysis comparing distal splenorenal shunt with sclerotherapy found that shunt placement significantly reduced the rate of recurrent bleeding, but also increased the incidence of encephalopathy and did not improve survival [38]. Similarly, with TIPS compared with endoscopic therapy, the rebleeding rate was significantly lower with TIPS (19% vs 47%), but the incidence of encephalopathy was higher with TIPS (34% vs 19%), with no difference in survival [39].…”

Section: Prevention Of Recurrent Variceal Hemorrhagementioning

confidence: 99%

Current management of esophageal varices

Zaman

2003

Curr Treat Options Gastro

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Acute variceal hemorrhage is the most lethal complication of cirrhosis. The reported mortality rate from a first episode of variceal hemorrhage is 17% to 57%. Management of varices can be categorized into three phases: 1) prevention of initial bleeding, 2) management of acute bleeding, and 3) prevention of rebleeding. Modalities for treatment include pharmacologic, endoscopic, and shunt therapy. For the prevention of first variceal hemorrhage, cirrhotic patients should undergo endoscopy to identify patients with large varices. Priority for screening for varices should be given to patients with low platelet count, splenomegaly, and advanced cirrhosis. Once large varices are identified, patients should be started on beta-blocker therapy, which reduces the risk of bleeding by 50%. If pharmacologic therapy is not tolerated or contraindicated, endoscopic band ligation should be performed, and surveillance of varices should be performed every 6 months thereafter. Shunt procedures are not indicated due to their higher rates of complications compared with medical therapy. For the management of acute variceal hemorrhage, patients should be started on prophylactic intravenous antibiotics and intravenous octreotide. Endoscopy should be performed to diagnose and treat variceal hemorrhage. Band ligation appears to be as effective as sclerotherapy, but with less complications. If hemostasis is not achieved, balloon tamponade can be used as a bridge to definitive therapy, which in this case would be a transjugular intrahepatic portosystemic shunt (TIPS). If TIPS is unavailable, a surgical shunt is indicated. Once an episode of acute bleeding has been controlled, variceal eradication is best accomplished with repeat band ligation every 10 to 14 days until varices are obliterated. Prevention of recurrent bleeding can be achieved with beta-blocker therapy. The addition of isosorbide mononitrate further reduces recurrent bleeding. This combination pharmacologic therapy has been shown to be superior to sclerotherapy and may be superior to band ligation. However, side effects of combination pharmacologic therapy may limit its effectiveness. Band ligation is preferred to sclerotherapy when considering endoscopic therapy due to less complications and lower cost. Surgical shunts should be used for prevention of rebleeding in patients who do not tolerate or are noncompliant with medical therapy and who have relatively preserved liver function. TIPS should be reserved for patients who have poor liver function and who have failed medical therapy.

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Distal spleno-renal shunt versus endoscopic sclerotherapy in the prevention of variceal rebleeding

Cited by 73 publications

References 34 publications

Small-Diameter Portacaval H-Graft Shunt: A Paradigm Shift Back to Surgical Shunting in the Management of Variceal Bleeding in Patients With Preserved Liver Function

Small-Diameter Portacaval H-Graft Shunt: A Paradigm Shift Back to Surgical Shunting in the Management of Variceal Bleeding in Patients With Preserved Liver Function

Surgical outcomes of distal splenorenal shunt or liver transplantation in treatment of schistosomal refractory variceal bleeding

Current management of esophageal varices

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