Improved survival after prophylactic portal nondecompression surgery for esophageal varices: A randomized clinical trial
✍ Scribed by Dr. Kiyoshi Inokuchi
- Publisher
- John Wiley and Sons
- Year
- 1990
- Tongue
- English
- Weight
- 480 KB
- Volume
- 12
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
To evaluate prophylactic surgery for esophageal varices, a prospective randomized controlled trial was begun in 1980 by the Japanese Research Society for Portal Hypertension. Methods of operation included selective shunts and nonshunthg interruption proceduree. One hundred and twelve Japanese patients, in whom endoecopic findings suggested ria% of bleeding but who had no bleeding episode, were randody allocated to the operated group of 60 patients or nonoperated group of 52 patients. Nine patients with idiopathic portal hypertension, histologically proven noncirrhotic disease, which all fell in the operated group, were excluded from the study and the remaining 103 patients (51 operated and 52 nonoperated) were analyzed. Long-term follow-up of patients for a median of 49 mo with a maximum of 73 mo showed a total of 11 (22%) deaths, including 2 operative deaths, in the operated group compared with 23 (49%) deaths in the nonoperated group. The cumulative survival rate at 5 yr in the operated group was 72%, which wae significantly higher than the 45% of the nonoperated group (p < 0.05). The cumulative variceal bleedfng rate at 5 yr was 7% in the operated group, which was significantly lower than that of the nonoperated group of 46% (p < 0.001). It was concluded that portal nondecompregsion surgery was effective in preventing the variced bleeding and in improving survival. (HEIJATOLBGY 1990; 12: 1-6.)