Long-term results of esophagogastric devascularization and splenectomy associated with endoscopic treatment in schistosomal portal hypertension.
BACKGROUND
Esophagogastric devascularization and splenectomy (EGDS) is the most performed operation for prophylaxis of esophageal varices bleeding recurrence in hepatosplenic schistosomiasis. Lower rebleeding rates are obtained through the association of postoperative endoscopic treatment; however, there is a dearth of studies showing long-term results.


METHODS
Clinical, laboratory, and endoscopic data of 97 patients submitted to EGDS with at least 5 years of follow-up, were analyzed.


RESULTS
The mean follow-up was 116.4 months. Bleeding recurrence occurred in 24.7% of patients; however, this percentage was 14.6% when only variceal hemorrhage was considered. Bleeding recurrence occurred in four patients even after endoscopic evaluation demonstrated esophageal varices eradication. In the late follow-up we observed normalization of anemia, leukopenia, thrombocytopenia, hyperbilirubinemia, and a prothrombin activity time increase. No clinical or laboratory hepatic insufficiency was observed.


CONCLUSIONS
The EGDS procedure with postoperative endoscopic treatment led to good clinical results and avoided hemorrhagic recurrence in 75.3% of schistosomal patients. There was improvement of laboratory measures of hepatic function, as well as correction of hypersplenism. Variceal hemorrhagic recurrence may occur even when esophageal varices eradication is reached.
Makdissi
Fabio Ferrari
FF
Department of Gastroenterology, University of São Paulo School of Medicine, Rua Sena Madureira, 1265, apto 11, Vila Clementino, São Paulo, CEP 04021-051, Brazil. ffmakdissi@gmail.com
Herman
Paulo
P
Pugliese
Vincenzo
V
de Cleva
Roberto
R
Saad
William Abrão
WA
Cecconello
Ivan
I
D'Albuquerque
Luiz Augusto Carneiro
LA
D000293:Adolescent; D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000628:therapy; D004947:Esophagus / Q000098:blood supply / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012552:Schistosomiasis / Q000150:complications*; D055502:Secondary Prevention; D013156:Splenectomy; D013270:Stomach / Q000098:blood supply / Q000601:surgery*; D055815:Young Adult