Unshuntable extrahepatic portal hypertension revisited: 43 years' experience with radical esophagogastrectomy treatment of bleeding esophagogastric varices.
BACKGROUND
In 1994, the authors reported their experience with radical esophagogastrectomy for bleeding esophagogastric varices due to unshuntable extra-hepatic portal hypertension. Since then, the series has expanded from 22 to 44 patients. The aim of this study was to assess the validity of the previous observations and conclusions in the largest series with the longest follow-up.


METHODS
From 1968 to 2005, 44 patients with unshuntable extra-hepatic portal hypertension were treated by total gastrectomy and resection of the distal two thirds of the esophagus. Before referral, the patients experienced 4 to 24 episodes of variceal bleeding requiring a mean 130 U of blood transfusion, 15 hospital admissions, and 6 previous unsuccessful operations.


RESULTS
Transient postoperative complications occurred in 50% of patients. The survival rate is 100%, with no recurrence of variceal bleeding during 7 to 43 years of follow-up. Liver function and biopsy results have been normal. Quality of life has been excellent or good in 91%. Eighty-six percent have resumed employment or full-time housekeeping.


CONCLUSIONS
In unshuntable extra-hepatic portal hypertension, radical esophagogastrectomy is the only consistently effective treatment of variceal hemorrhage. Prompt use of this lifesaving procedure is warranted.
Department of Surgery, University of California, San Diego, Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8999, USA. Electronic address: morloff@ucsd.edu.
Marshall J
MJ
Orloff
Department of Surgery, Division of Organ Transplantation, University of Rochester Medical Center Rochester, NY, USA.
Mark S
MS
Orloff
Department of Surgery, Division of Abdominal Organ Transplantation, Oregon Health & Sciences University, Portland, OR, USA.
Susan L
SL
Orloff
Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco, Medical Center, San Francisco, CA, USA.
Lisa A
LA
Orloff
Department of Surgery, University of California, San Diego, Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8999, USA.
Pat O
PO
Daily
Department of Surgery, University of California, San Diego, Medical Center, 200 West Arbor Drive, San Diego, CA 92103-8999, USA.
Barbara
B
Girard
Department of Medicine/Gastroenterology, University of California, San Diego, Medical Center, San Diego, CA, USA.
Jon I
JI
Isenberg
Department of Medicine/Gastroenterology, University of California, San Diego, Medical Center, San Diego, CA, USA.
Henry O
HO
Wheeler
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000209:etiology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000503:physiopathology; D007223:Infant; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome
Bleeding esophagogastric varices; Radical esophagogastrectomy; Unshuntable extrahepatic portal hypertension