Endoscopic variceal ligation combined with Hassab's procedure in preventing the recurrence of esophageal varices.
OBJECTIVE
To assess the efficacy of endoscopic variceal ligation (EVL) combined with Hassab's procedure in the prevention of variceal recurrence.


METHODS
One hundred and thirty-five patients with esophageal varices were randomized to receive EVL alone, Hassab's procedure alone or a combination of EVL and Hassab's procedure for variceal eradication. Ultrasonographic venous network images were recorded by an esophageal microprobe before and after the EVL or Hassab's procedure. The clinical outcome and vascular network images of the 3 groups were analyzed.


RESULTS
Esophageal varices were obliterated immediately after EVL alone, while both perforating veins and periesophageal collaterals remained patent, and 83% had recurrence of esophageal varices during an initial 3-year follow-up. Esophageal varices were reduced in size, periesophageal collaterals were obliterated after Hassab's procedure alone, and 30% experienced rebleeding and 95% with variceal recurrence. EVL combined with Hassab's procedure obliterated all esophageal varices, perforating veins and periesophageal collaterals, and only 3 patients (8%) recurred.


CONCLUSIONS
The existence of patent perforating veins and periesophageal collaterals is the reason of esophageal variceal recurrence after EVL alone. EVL combined with Hassab's procedure can effectively prevent the recurrence, even if the cirrhojtic portal hypertension persisted.
Qi
You-fei
YF
Department of General Surgery, Third Xiangya Hospital, Central South University, 410013, China.
Zhu
Shai-hong
SH
Liu
Xun-yang
XY
Liu
Bo
B
Li
Rui-zhen
RZ
Zhou
Ping
P
Wang
Guo-hui
GH
D000293:Adolescent; D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D004945:Esophagoscopy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008026:Ligation; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D013156:Splenectomy