Long-term follow-up study of adult patients with non-cirrhotic obstruction of the portal system: comparison with cirrhotic patients

Merkel, Carlo; Bolognesi, Massimo; Bellon, S.; Sacerdoti, David; Bianco, Simone; Amodio, Piero; Gatta, Angelo

doi:10.1016/0168-8278(92)90059-x

Cited by 44 publications

(28 citation statements)

References 21 publications

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“…In our series, the 15-year prognosis of patients with IPH was better than that reported for patients with liver cirrhosis, if variceal bleeding was controlled. 19,20 This finding is in accordance with recent reports by Orozco et al 21 and Ichimura et al 8 Since 1979, we have selected non-shunt operation as the first line treatment for two reasons: 22,23 (1) A high rate of variceal eradication is achieved by non-shunt operation. (2) The incidence of variceal recurrence and rebleeding is very low after successful non-shunt operation.…”

Section: Discussionsupporting

confidence: 91%

Long-Term prognosis of non-shunt operation for idiopathic portal hypertension

Ohashi

Kojima

Fukazawa

et al. 1998

Journal of Gastroenterology

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This report presents 46 Japanese patients with idiopathic portal hypertension (IPH) in whom non-shunt operation was performed for the management of esophageal varices. Non-shunt operation included transthoracic esophageal transection (Sugiura's procedure) in 37 patients, transabdominal esophageal transection (TAET) in 3 patients, and Hassab's procedure in 6 patients. Rates of postoperative variceal eradication were: 78.4% by Sugiura's procedure; 100% by TAET; and 50% by Hassab's procedure. The cumulative rates for recurrent varices and recurrent bleeding were 3.9%, and 5.1%, respectively, at 5 years, and 8.9% and 9.8% at both 10 and 15 years. Only 3 patients required additional endoscopic injection sclerotherapy to treat recurrent varices. Although 3 patients developed upper gastrointestinal bleeding, the source of hemorrhage was esophageal varices in 1, and portal hypertensive gastropathy in 2; none of the patients died from bleeding. Actuarial survival for all patients was 87.5% at 5 years, 77.9% at 10 years, and 58.8% at 15 years. There were no deaths within the first 30 days after surgery. These results show that non-shunt operation is useful in preventing bleeding from esophageal varices in patients with IPH.

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Section: Discussionsupporting

confidence: 91%

Long-Term prognosis of non-shunt operation for idiopathic portal hypertension

Ohashi

Kojima

Fukazawa

et al. 1998

Journal of Gastroenterology

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“…Groups from India and the Netherlands reported a negligible death probability due to recurrent EPVT induced variceal bleeding five years after sclerotherapy 1516 Merkel et al found that in comparison with patients with variceal bleeding due to cirrhosis, the outcome of bleeding for patients with non-cirrhotic EPVT was significantly better 17. This phenomenon can be explained by intact coagulation and liver function in patients with non-cirrhotic EPVT and possibly by the development of porto-portal collaterals which in time may stabilise portal pressure.…”

Section: Discussionmentioning

confidence: 99%

Extrahepatic portal vein thrombosis: aetiology and determinants of survival

Janssen

Wijnhoud²,

Haagsma³

et al. 2001

Gut

278

219

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Background-Malignancy, hypercoagulability, and conditions leading to decreased portal flow have been reported to contribute to the aetiology of extrahepatic portal vein thrombosis (EPVT). Mortality of patients with EPVT may be associated with these concurrent medical conditions or with manifestations of portal hypertension, such as variceal haemorrhage. Patients and methods-To determine which variables have prognostic significance with respect to survival, we performed a retrospective study of 172 adult EPVT patients who were followed over the period 1984-1997 in eight university hospitals. Results-Mean follow up was 3.9 years (range 0.1-13.1). Overall survival was 70% (95% confidence interval (CI) 62-76%) at one year, 61% (95% CI, 52-67%) at five years, and 54% (95% CI, 45-62%) at 10 years. The one, five, and 10 year survival rates in the absence of cancer, cirrhosis, and mesenteric vein thrombosis were 95% (95% CI 87-98%), 89% (95% CI 78-94%), and 81% (95% CI 67-89%), respectively (n=83). Variables at diagnosis associated with reduced survival according to multivariate analysis were advanced age, malignancy, cirrhosis, mesenteric vein thrombosis, absence of abdominal inflammation, and serum levels of aminotransferase and albumin. The presence of variceal haemorrhage and myeloproliferative disorders did not influence survival. Only four patients died due to variceal haemorrhage and one due to complications of a portosystemic shunt procedure. Conclusion-We conclude that mortality among patients with EPVT is related primarily to concurrent disorders leading to EPVT and not to complications of portal hypertension. (Gut 2001;49:720-724)

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“…Due to preserved liver function the survival of patients with variceal bleeding from noncirrhotic and nontumorous portal vein thrombosis is better than in cirrhosis [43]. In a mixed group of patients with portal vein thrombosis (PVT) survival was primarily related to concurrent disease leading to extrahepatic PVT (EPVT) and not to variceal bleeding [36].…”

Section: Etiology Of Epvomentioning

confidence: 99%

Current state of portosystemic shunt surgery

Wolff

Hirner

2003

Langenbeck's Archives of Surgery

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In cirrhotics, elective operations using portal flow preserving techniques such as a selective distal splenorenal shunt (Warren) and a partial portocaval small diameter interposition shunt (Sarfeh) should be preferred. Rarely, end-to-side portocaval shunt may serve as a salvage procedure if emergency endoscopic treatment or transjugular intrahepatic portosystemic shunt insertion fails to stop bleeding. Until definitive results from randomized trials are available patients with good prognosis (Child-Pugh A and B) should be regarded as candidates for surgical shunts. For patients with noncirrhotic portal hypertension, in particular with extrahepatic portal vein thrombosis, portosystemic shunt surgery represents the only effective therapy which leads to freedom of recurrent bleeding and repeated endoscopies for many years, and improves hypersplenism without deteriorating liver function or encephalopathy. Gastroesophageal devascularization and other direct variceal ablative procedures should be restricted to treat endoscopic therapy failures without shuntable portal tributaries.

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Long-term follow-up study of adult patients with non-cirrhotic obstruction of the portal system: comparison with cirrhotic patients

Cited by 44 publications

References 21 publications

Long-Term prognosis of non-shunt operation for idiopathic portal hypertension

Long-Term prognosis of non-shunt operation for idiopathic portal hypertension

Extrahepatic portal vein thrombosis: aetiology and determinants of survival

Current state of portosystemic shunt surgery

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