title: Evaluation of the effects of combined endoscopic variceal ligation and splenectomy with pericardial devascularization on esophageal varices.
abstract: 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.
authors.affiliation: Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Liu
authors.forename: Mei-Hai
authors.initials: MH
authors.lastname: Deng
authors.forename: Nan
authors.initials: N
authors.lastname: Lin
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Pan
authors.forename: Yun-Biao
authors.initials: YB
authors.lastname: Ling
authors.forename: Rui-Yun
authors.initials: RY
authors.lastname: Xu
mesh_terms: 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