The acute treatment of haemorrhage from oesophageal varices: A comparison of oesophageal transection and staple gun anastomosis with mesocaval shunt

Osborne, D. R.; Hobbs, K. E. F.

doi:10.1002/bjs.1800681019

Cited by 39 publications

(8 citation statements)

References 7 publications

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“…In the emergency setting, simple esophageal transection is associated with a hospital mortality of 21% to 100% [28][29][30][31] and reaches 57% to 100% in high-risk Child class C patients. It is no surprise therefore that the Sugiura operation, which is of considerably greater magnitude than a simple esophageal transection, has an equal or higher mortality rate when at-tempted in Child class C patients and in the emergency setting (Table 1).…”

Section: Operative Mortalitymentioning

confidence: 99%

Experience with Radical esophagogastric devascularization procedures (Sugiura) for variceal bleeding outside Japan

et al. 1994

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The Sugiura operation has been reported to have low operative mortality, rebleeding, and encephalopathy rates when carried out in a predominantly nonalcoholic Japanese population with good liver function. A literature review of reports of the Sugiura procedure outside Japan reveals a high complication and mortality rate when it is used as an emergency procedure in patients with advanced liver disease, especially in those with alcoholic cirrhosis. Uncontrolled studies report results that differ little from the Japanese series when the operation is confined to good-risk patients in the elective situation. Our experience with the Sugiura operation supports its role in these circumstances, especially in patients with portal vein thrombosis and normal liver function. The only good prospective controlled trial has been carried out in patients with schistosomiasis and suggests that the Sugiura operation is far superior to total shunt and may have a slight advantage over the Warren shunt because of its low incidence of postoperative encephalopathy. More controlled trials are required to establish its role in good- to moderate-risk patients with alcoholic cirrhosis.

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Section: Operative Mortalitymentioning

confidence: 99%

Experience with Radical esophagogastric devascularization procedures (Sugiura) for variceal bleeding outside Japan

et al. 1994

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“…The operation was performed through a left subcostal incision and esophageal transection, and anastomosis was effected with a 28-mm or 31-mm EEA circular stapling instrument (Auto Suture Co., U K Kings Ride, Ascot, UK) as described previously (12). No paraesophageal devascularization was performed with our technique.…”

Section: Andrew K Burroughsmentioning

confidence: 99%

Bleeding From Staple Line Erosion After Esophageal Transection: Effect of Omeprazole

et al. 1992

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Esophageal staple transection effectively controls acute variceal bleeding, but up to 50% of these patients will have recurrent upper gastrointestinal bleeding. In our experience, most of these bleeding episodes are caused by total or partial circumferential ulceration at the level of the staple transection: staple line erosion. It caused rebleeding in 29 (40%) of our patients. Whereas the pathogenesis of this lesion is unknown, acid reflux is a consequence of transection surgery. Assuming that staple line erosion could be healed by acid suppression therapy, thereby preventing recurrent bleeding, an acid suppression regimen was evaluated prospectively in 24 patients. Only six (25%) healed with daily standard (300 mg) or high-dose (1,200 mg) ranitidine combined with sucralfate (4 gm). The remaining 18 (75%) healed after omeprazole administration (40 mg/day) for 1 mo. Maintenance ranitidine alone (300 mg/day) was introduced, but 11 (48%) had relapse of erosions. All 11 healed with omeprazole (40 mg/day) for 2 mo, but again on maintenance ranitidine, 10 relapsed. All healed with further omeprazole and healing persisted with long-term administration (20 mg/day). Fifteen rebleeding episodes occurred in eight patients on maintenance ranitidine. Whereas relapse of staple line erosions did occur in the absence of rebleeding, all rebleeding episodes were associated with the relapse of staple line erosion. Omeprazole is more effective than ranitidine alone and combined with sucralfate in healing staple line erosion. Omeprazole prevents rebleeding, which may enhance the long-term benefits of staple transection for acute variceal bleeding.

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“…However, considerable interest has been evoked by the introduction of the staple gun. Simple staple gun transection of the lower oesophagus has been shown to be highly effective in controlling acute variceal bleeding [9,36], but may have the disadvantage of increased rebleeding at a later stage. The addition of extensive devascularisation increases the magnitude of the emergency operation.…”

Section: Urgent Specific Therapymentioning

confidence: 99%

The use of sclerotherapy for the management of oesophageal varices in portal hypertension

Terblanche

1988

Surg Endosc

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Although sclerotherapy is currently the most widely used treatment for the management of both acute variceal bleeding and the long-term management of patients with varices, its definitive role in the treatment of these patients has yet to be finally proven. Sclerotherapy appears to be the most effective treatment for the majority of patients with acute variceal bleeding. Failures require either a shunt or a transection and/or devascularisation procedure. Current evidence favours simple staple gun transection or a shunt (either a portacaval shunt or a side-to-side narrow diameter polytetrafluoroethylene graft between the portal vein and vena cava). In long-term management of patients after a variceal bleed the currently favoured treatment is repeated sclerotherapy. However, failures should be identified early. We define failures as patients who present with varices that are either difficult to eradicate by sclerotherapy or who have repeated life-threatening variceal bleeds during the course of repeated injection sclerotherapy. Such patients should have either a portal-to-systemic shunt or a transection and devascularisation operation. Further controlled trials are required to define the specific indications for the individual forms of therapy. Prophylactic treatment for varices that have not yet bled is unjustified at present.

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The acute treatment of haemorrhage from oesophageal varices: A comparison of oesophageal transection and staple gun anastomosis with mesocaval shunt

Cited by 39 publications

References 7 publications

Experience with Radical esophagogastric devascularization procedures (Sugiura) for variceal bleeding outside Japan

Experience with Radical esophagogastric devascularization procedures (Sugiura) for variceal bleeding outside Japan

Bleeding From Staple Line Erosion After Esophageal Transection: Effect of Omeprazole

The use of sclerotherapy for the management of oesophageal varices in portal hypertension

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