Bleeding Oesophageal Varices. A Clinical Study of Mesocaval Interposition Shunting and Endoscopic Sclerotherapy

University dissertation from Department of Surgery, Lund University, S-221 85 Lund, Sweden

Abstract: This thesis is aimed at evaluating the clinical results of two treatments in patients with bleeding oesophageal varices; the mesocaval interposition shunt (MI shunt) and repeated endoscopic sclerotherapy (ST). 24 patients were randomised to MI shunt and 21 patients to the ST group (mean age 51.6?9.2 and 53.6?10.5 years). Complications include shunt occlusion in 4 %, oesophagitis in 33 % and oesophageal stricture in 10 %. There was a significantly higher rebleeding rate in the ST group (18 vs 3), survival was not affected by treatment except in Child's C patients where a slightly longer survival was found in the MI group. Evaluation of hepatic encephalopathy showed that the MI group showed a progressive general reduction as opposed to the ST group during 1 year follow-up. The MI shunt did not induce any major alterations of gastrointestinal hormones, amino acids or lysosomal enzymes during long-term follow-up. In a second study we evaluate the total experience of MI shunt surgery during the same period. This re

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