Prophylactic portacaval anastomosis in cirrhotic patients with esophageal varices and ascites

Conn, Harold O.; Lindenmuth, W. W.

doi:10.1016/0002-9610(69)90401-2

Cited by 28 publications

(7 citation statements)

References 11 publications

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“…The results in these patients are generally poor, which is not surprising when considering that these patients are not only very poor operative risks but also that porto-caval shunt per se implies an increased risk of liver insufficiency and hepatic coma. In spite of this, these patients seem to have been included in most published materials and some studies have been restricted to patients with ascites [3,10]. In my opinion, the group A patients constitute the most interesting candidates for shunt operation, since: (a) in these patients the operations can usually be performed after a reasonable period of recovery after bleeding (cf.…”

Section: Discussionmentioning

confidence: 99%

The Natural History of Esophageal Varices

Olsson

1972

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Esophageal varices were observed at autopsy in 150 of 244 patients (61%) with liver cirrhosis. Of these patients, 100 (67%) had bled from their varices intra vitam. Approximately 80% of the patients who had once bled from their varices died in variceal bleeding, 25% as a result of their first bleeding. In every fourth patient who died in variceal bleeding, the bleeding was not diagnosed ante mortem. A marked difference in prognosis after the first bleeding was apparent when the patients were classified with respect to the liver function at the time of the first bleeding. The prognosis at the time of the first registered signs of liver cirrhosis was not worse for the patients with bleeding varices. In many respects the impairment in liver functions at death seemed less pronounced in the patients with bleeding esophageal varices.

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Section: Discussionmentioning

confidence: 99%

The Natural History of Esophageal Varices

Olsson

1972

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“…Thirty to seventy percent of patients with liver cirrhosis develop esophageal varices [14], but only 20%-40% of these patients bleed from their varices during a follow-up period of about 2 to 14 years [1,15,16,35,67]. Overall mortality of first variceal hemorrhage was 50% in the Copenhagen study [89].…”

Section: Epidemiology Of First Varieeal Bleedingmentioning

confidence: 99%

“…Four randomized controlled trials [15,16,31,67] have been carried out in the 1960s and early 1970s. All of these studies showed that despite preventing variceal hemorrhage, prophylactic shunts failed to prolong survival [11].…”

Section: Prophylactic Shunt Operationsmentioning

confidence: 99%

Prophylaxis of first variceal hemorrhage in patients with liver cirrhosis

et al. 1986

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Summary. Prophylaxis of bleeding from esophageal varices is a very tempting concept at first glance, especially under the assumption of a high mortality associated with first variceal hemorrhage. Up to now four different measures have been tried for prophylaxis: portacaval shunt operation, devascularization procedures, sclerotherapy, and drugs. With the exception of portacaval shunts, ongoing controlled trials show a weak trend toward reduction of variceal bleeding and prolongation of survival in selected patients with compensated cirrhosis and large varices. However, prophylaxis of first variceal bleeding must still be regarded as experimental and should be restricted to controlled clinical studies.

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“…In these studies, an end-to-side portacaval shunt was used in most cases; the diagnosis of cirrhosis was anatomically proven; portal hypertension was documented by an oesophageal baryum transit and/ or an oesophagofiberendoscopy and/or a splenoportography; in 90% of the cases, cirrhosis was of alcoholic aetiology; the degree of liver failure was not taken into consideration. In the groups of patients described in these studies 'unselected patients' [17], 'patients with recent ascites, jaundice or encepha lopathy' [38], 'alcoholic in lower socioeconomic groups' [69], portacaval shunt decreased the hemorrhagic risk, but it did not increase survival. One of these studies is of particular interest because it shows one possibility of the controlled trial: the characterization of a subgroup.…”

Section: Digestive Hemorrhages and Portal Hypertensionmentioning

confidence: 99%

“…Three controlled trials [17,38,69] have tested the value of this treatment. In these studies, an end-to-side portacaval shunt was used in most cases; the diagnosis of cirrhosis was anatomically proven; portal hypertension was documented by an oesophageal baryum transit and/ or an oesophagofiberendoscopy and/or a splenoportography; in 90% of the cases, cirrhosis was of alcoholic aetiology; the degree of liver failure was not taken into consideration.…”

Section: Digestive Hemorrhages and Portal Hypertensionmentioning

confidence: 99%

Portal-Systemic Shunts in Patients with Cirrhosis

Rueff¹,

Maillard²

1974

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The purpose of this progress report is to make a critical review of the current indications of portal-systemic shunts in cirrhotic patients and to emphasize the necessity (and the difficulties) of controlled clinical trials. The following items were successively studied: (1) portacaval shunt in patients with intractable ascites; (2) prophylactic portacaval shunt; (3) emergency portal-systemic shunts, and (4) elective portal-systemic shunts.

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Prophylactic portacaval anastomosis in cirrhotic patients with esophageal varices and ascites

Cited by 28 publications

References 11 publications

The Natural History of Esophageal Varices

The Natural History of Esophageal Varices

Prophylaxis of first variceal hemorrhage in patients with liver cirrhosis

Portal-Systemic Shunts in Patients with Cirrhosis

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