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The modified distal splenorenal shunt in the elective treatment of variceal hemorrhage.
Hepatogastroenterology. 1991 Dec; 38 Suppl 1:12-5.H

Abstract

We report on our experience with a modified version of the distal splenorenal shunt (DSRS) initially described by Warren. Since 1976 more than 150 shunts have been done in the department. The first part of this study shows the long-term results of a series of 100 consecutive patients treated electively. The estimated survival at 80 months was around 30%. On the other hand, the median survival rate (68 months) and the five-year survival (52%) of Child's A patients differed significantly from those of Child's B patients (8 months and 15%, respectively). These results suggested that the modified DSRS was an effective and relatively safe procedure for the elective treatment of variceal bleeding and warranted a prospective and randomized trial to compare DSRS and endoscopic sclerotherapy (ES). In the second part of the study, in which ES was compared with DSRS, both modalities showed a similar survival rate, although patients in the DSRS group had a higher incidence of encephalopathy and patients in the ES group were more prone to rebleed. It was concluded that ES was a good alternative to DSRS for the elective treatment of esophageal variceal bleeding. If orthotopic liver transplant is considered the only definitive mode of treatment for the elective management of portal hypertension, the DSRS should be reserved for patients in whom ES has not been totally effective, or varices are located predominantly in the fundus of the stomach.

Authors+Show Affiliations

Department of Surgery, Hospital Clínico y Provincial de Barcelona, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

1823061

Citation

Pera, C, et al. "The Modified Distal Splenorenal Shunt in the Elective Treatment of Variceal Hemorrhage." Hepato-gastroenterology, vol. 38 Suppl 1, 1991, pp. 12-5.
Pera C, Visa J, García-Valdecasas JC, et al. The modified distal splenorenal shunt in the elective treatment of variceal hemorrhage. Hepatogastroenterology. 1991;38 Suppl 1:12-5.
Pera, C., Visa, J., García-Valdecasas, J. C., Grande, L., & Fuster, J. (1991). The modified distal splenorenal shunt in the elective treatment of variceal hemorrhage. Hepato-gastroenterology, 38 Suppl 1, 12-5.
Pera C, et al. The Modified Distal Splenorenal Shunt in the Elective Treatment of Variceal Hemorrhage. Hepatogastroenterology. 1991;38 Suppl 1:12-5. PubMed PMID: 1823061.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The modified distal splenorenal shunt in the elective treatment of variceal hemorrhage. AU - Pera,C, AU - Visa,J, AU - García-Valdecasas,J C, AU - Grande,L, AU - Fuster,J, PY - 1991/12/1/pubmed PY - 1991/12/1/medline PY - 1991/12/1/entrez SP - 12 EP - 5 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 38 Suppl 1 N2 - We report on our experience with a modified version of the distal splenorenal shunt (DSRS) initially described by Warren. Since 1976 more than 150 shunts have been done in the department. The first part of this study shows the long-term results of a series of 100 consecutive patients treated electively. The estimated survival at 80 months was around 30%. On the other hand, the median survival rate (68 months) and the five-year survival (52%) of Child's A patients differed significantly from those of Child's B patients (8 months and 15%, respectively). These results suggested that the modified DSRS was an effective and relatively safe procedure for the elective treatment of variceal bleeding and warranted a prospective and randomized trial to compare DSRS and endoscopic sclerotherapy (ES). In the second part of the study, in which ES was compared with DSRS, both modalities showed a similar survival rate, although patients in the DSRS group had a higher incidence of encephalopathy and patients in the ES group were more prone to rebleed. It was concluded that ES was a good alternative to DSRS for the elective treatment of esophageal variceal bleeding. If orthotopic liver transplant is considered the only definitive mode of treatment for the elective management of portal hypertension, the DSRS should be reserved for patients in whom ES has not been totally effective, or varices are located predominantly in the fundus of the stomach. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/1823061/The_modified_distal_splenorenal_shunt_in_the_elective_treatment_of_variceal_hemorrhage_ L2 - https://medlineplus.gov/gastrointestinalbleeding.html DB - PRIME DP - Unbound Medicine ER -