Evaluation of the effects of combined endoscopic variceal ligation and splenectomy with pericardial devascularization on esophageal varices.
OBJECTIVE
To detect the hemodynamic alterations in collateral circulation before and after combined endoscopic variceal ligation (EVL) and splenectomy with pericardial devascularization by ultrasonography, and to evaluate their effect using hemodynamic parameters.


METHODS
Forty-three patients with esophageal varices received combined EVL and splenectomy with pericardial devascularization for variceal eradication. The esophageal vein structures and azygos blood flow (AZBF) were detected by endoscopic ultrasonography and color Doppler ultrasound. The recurrence and rebleeding of esophageal varices were followed up.


RESULTS
Patients with moderate or severe varices in the esophageal wall and those with severe peri-esophageal collateral vein varices had improvements after treatment, while the percentage of patients with severe para-esophageal collateral vein varices decreased from 54.49% to 2.33%, and the percentage of patients with detectable perforating veins decreased from 79.07% to 4.65% (P < 0.01). Color Doppler flowmetry showed a significant decrease both in AZBF (43.00%, P < 0.05) and in diameter of the azygos vein (28.85%, P < 0.05), while the blood flow rate was unchanged. The recurrence rate of esophageal varices was 2.5% (1/40, mild), while no re-bleeding cases were recorded.


CONCLUSIONS
EVL in combination with splenectomy with pericardial devascularization can block the collateral veins both inside and outside of the esophageal wall, and is more advantagious over splenectomy in combination with pericardial devascularization or EVL in preventing recurrence and re-bleeding of varices.
Liu
Bo
B
Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China.
Deng
Mei-Hai
MH
Lin
Nan
N
Pan
Wei-Dong
WD
Ling
Yun-Biao
YB
Xu
Rui-Yun
RY
D000328:Adult; D000368:Aged; D001401:Azygos Vein / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001775:Blood Circulation / Q000502:physiology; D004724:Endoscopy / Q000379:methods*; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004947:Esophagus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D012008:Recurrence; D012039:Regional Blood Flow / Q000502:physiology; D013156:Splenectomy / Q000379:methods*; D018615:Ultrasonography, Doppler, Color