Prevention of recurrent bleeding from varicose veins of the esophagus and stomach among patients with decompensated liver cirrhosis

Abstract

Aim. To evaluate the efficiency of laparoscopic devascularization of the esophagus and stomach with endoscopic ligation of varicose esophageal veins in the prevention of esophageal-gastric bleeding among patients with decompensated liver cirrhosis.

Methods. The results of treatment of 73 patients with decompensated liver cirrhosis and high risk of bleeding were analyzed. To prevent recurrent bleeding from esophageal and gastric veins, all patients underwent endoscopic ligation at the first step of treatment. In case of inefficiency of ligation and recurrence of varicose veins of esophagus, laparoscopic devascularization of esophagus and stomach was performed. The efficiency of laparoscopic devascularization with intraoperative endoscopic ligation of varicose esophageal veins and ligation as an independent method of treatment for the prevention of upper gastrointestinal bleeding was estimated by comparison of the frequency of recurrence of esophageal and gastric bleeding and recurrence of esophageal varices according to upper endoscopy in comparison groups.

Results. In 6 months, 1 and 2 years after laparoscopic devascularization of the esophagus and stomach in combination with endoscopic ligation, the risk of bleeding is less compared to endoscopic ligation as an isolated treatment method (p=0.05; p=0.052; p=0.06). Laparoscopic devascularization with ligation reduces the risk of recurrence of esophageal varices during the first year after surgery by 20% (χ2=2.61; p=0.106), in 2 years by 23% (χ2=1.75; p=0.091) compared to endoscopic ligation only.

Conclusion. Patients with liver cirrhosis with decompensated hepatic failure satisfactorily postpone endovideosurgical interventions; laparoscopic gastric devascularization with the intersection of the main inflows to the esophageal varicose veins is an effective method to prevent esophageal-gastric hemorrhage among patients with decompensated liver cirrhosis after ineffective endoscopic ligation.

Keywords

liver cirrhosis / portal hypertension / esophageal varices / laparoscopic devascularization of esophagus

References

[1] Nazyrov F.G., Devyatov A.V., Babadzhanov A.H., Dzhumaniyazov D.A. Efficiency of endoscopic interventions at patients with cirrhosis. Annaly khi­rurgicheskoy gepatologii. 2017; 22 (2): 45–53. (In Russ.)

[2] Назыров Ф.Г., Девятов А.В., Бабаджанов А.Х., Джуманиязов Д.А. Эффективность эндоскопических вмешательств у больных циррозом печени. Анн. хир. гепатол. 2017; 22 (2): 45-53. DOI: 10.16931/1995-5464.2017245-53.

[3] Kotiv B.N., Dzidzava I.I., Soldatov S.A. Results of selective and partial portocaval shunting and prognostic factors of long-term survival of patients with cirrhosis. Annaly khirurgicheskoy gepatologii. 2015; 20 (2): 46–58. (In Russ.)

[4] Котив Б.Н., Дзидзава И.И., Солдатов С.А. Результаты селективного и парциального портокавального шунтирования и прогностические факторы долгосрочной выживаемости больных циррозом печени. Анн. хир. гепатол. 2015; 20 (2): 46-58. DOI: 10.16931/1995-5464.2015246-58.

[5] Габриэль С.А., Гучетль А.Я., Дурлештер В.М. Эффективность эндоскопического лигирования варикозно-

[6] Габриэль С.А., Гучетль А.Я., Дурлештер В.М. Эффективность эндоскопического лигирования варикознорасширенных вен пищевода. Вестн. МУЗГБ. 2016; 23 (13): 25.

[7] Gabriel S.A., Guchetl A.Ya., Durleshter V.M. Efficiency of an endoscopic ligation of varicose veins of an esophagus. Vestnik MUZGB. 2016; 23 (13): 25. (In Russ.)

[8] Шерцингер А.Г., Жигалова С.Б., Семёнова Т.С. Роль эндоскопии в выборе лечения больных портальной гипертензией. Анн. хир. гепатол. 2015; 20 (2): 20-30. DOI: 10.16931/1995-5464.2015220-30.

[9] Shertsinger A.G., Zhigalova S.B., Semenova T.S. Endoscopy role in the choice of treatment of patients with a portal hypertensia. Annaly khirurgicheskoy gepatologii. 2015; 20 (2): 20–30. (In Russ.)

[10] Jiang M., Liu F., Xiong W. Combined MELD and blood lipid level in evaluating the prognosis of decompensated cirrhosis. World J. Gastroenterol. 2010; 16 (11): 1397-1401. DOI: 10.3748/wjg.v16.i11.1397.

[11] Jiang M., Liu F., Xiong W. Combined MELD and blood lipid level in evaluating the prognosis of decompensated cirrhosis. World J. Gastroenterol. 2010; 16 (11): ­1397–1401. DOI: 10.3748/wjg.v16.i11.1397.

[12] Costa Lacet C., Neto J., Ribeiro L., Oliveira F. Schistosomal portal hypertension: Randomized trial comparing endoscopic therapy alone or preceded by esophagogastric devascularization and splenectomy. Ann. Hepatol. 2016; 15 (5): 738-744. PMID: 27493113.

[13] Costa Lacet C., Neto J., Ribeiro L., Oliveira F. Schistosomal portal hypertension: Randomized trial comparing endoscopic therapy alone or preceded by esophagogastric devascularization and splenectomy. Ann. Hepatol. 2016; 15 (5): 738–744. PMID: 27493113.

[14] Котив Б.Н. Хирургическая профилактика и лечение пищеводно-желудочных кровотечений при портальной гипертензии. Дисс. … докт. мед. наук. СПб. 1998; 195 с.

[15] Kotiv B.N. Surgical prophylaxis and ­treatment of esophageal and gastric bleedings at a portal hypertension. Thesis of the doctor of medical sciences. Saint Petersburg. 1998; 195 р. (In Russ.)

[16] Helmy A., Abdulkader Salama I., Schwaitzberg S.D. Laparoscopic esophagogastric devascularization in bleeding varices. Surg. Endosc. 2003; 17 (1): 1614-1619. DOI: 10.1007/s00464-002-8928-1.

[17] Helmy A., Abdulkader Salama I., Schwaitzberg S.D. Laparoscopic esophagogastric devascularization in blee­ding varices. Surg. Endosc. 2003; 17 (1): 1614–1619. DOI: 10.1007/s00464-002-8928-1.

[18] Akahoshi T., Uehara H., Tomikawa M. et al. Comparison of open, laparoscopic, and hand-assisted laparoscopic devascularization of the upper stomach and splenectomy for treatment of esophageal and gastric varices: a single-center experience. Asian J. Endosc. Surg. 2014; 7 (1): 138-144. DOI: 10.1111/ases.12096.

[19] Akahoshi T., Uehara H., Tomikawa M. et al. Comparison of open, laparoscopic, and hand-assisted laparoscopic devascularization of the upper stomach and splenectomy for treatment of esophageal and gastric varices: a single-center experience. Asian J. Endosc. Surg. 2014; 7 (1): 138–144. DOI: 10.1111/ases.12096.

[20] Danis J., Hubmann R., Pichler P. Novel technique of laparoscopic azygoportal disconnection for treatment of esophageal varicosis: preliminary experience with five patients. Surg. Endosc. 2004; 18 (4): 702-705. DOI: 10.1007/s00464-003-9096-7.

[21] Danis J., Hubmann R., Pichler P. Novel technique of laparoscopic azygoportal disconnection for treatment of esophageal varicosis: preliminary experience with five ­patients. Surg. Endosc. 2004; 18 (4): 702–705. DOI: 10.1007/s00464-003-9096-7.

[22] Tomikawa M. Effectiveness of gastric devascularization and splenectomy for patients with gastric varices. J. Am. Coll. Surg. 2000; 191 (5): 498-500. DOI: 10.1016/S1072-7515(00)00735-3.

[23] Tomikawa M. Effectiveness of gastric devascula­rization and splenectomy for patients with gastric varices. J. Am. Coll. Surg. 2000; 191 (5): 498–500. DOI: 10.1016/S1072-7515(00)00735-3.

[24] Kobayashi T., Miura K., Ishikawa H. et al. Handassisted laparoscopic Hassab’s procedure for esophagogastric varices with portal hypertension. Surg. Case Rep. 2017; 3 (3): 111. DOI: 10.1186/s40792-017-0387-y.

[25] Kobayashi T., Miura K., Ishikawa H. et al. Hand-assisted laparoscopic Hassab’s procedure for esopha­go­gastric varices with portal hypertension. Surg. Case Rep. 2017; 3 (3): 111. DOI: 10.1186/s40792-017-0387-y.

RIGHTS & PERMISSIONS

Onnitsev I.E., Bugaev S.A., Ivanusa S.Y., Dzidzava I.I., Khokhlov A.V., Kotiv B.N.