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Options for elective treatment of portal hypertension in cirrhotic patients in the transplantation era.
Am J Surg. 1990 Jul; 160(1):105-10.AJ

Abstract

We review herein our experience in the management of bleeding esophageal varices in cirrhotic patients and consider our findings in light of the dramatic changes in the treatment of cirrhosis resulting from the more widespread use of orthotopic liver transplantation (OLT). It does not seem realistic, at present, to propose OLT as the only effective treatment of variceal bleeding for a variety of reasons, and there remains a large group of patients who are noncompliant or unsuitable for liver transplantation. We propose that initial bleeding be controlled by endoscopic sclerotherapy, thereby allowing careful evaluation to be made electively. Grade A patients appear to be managed best by a reduced-size portacaval shunt (RPS) with prospects of good survival and few complications. Grade B patients can be managed by either sclerotherapy, RPS, or OLT, depending upon individual circumstances. Grade C patients are best managed by liver transplantation, again with excellent survival. In those grade C patients not deemed suitable for OLT (especially alcoholic patients), long-term endoscopic sclerotherapy is the best option. Changes in patient status may sometimes require revision of the treatment decision.

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Authors+Show Affiliations

Bismuth H
Hepatobiliary Surgery and Liver Transplant Unit, Faculty of Medicine of South Paris, Paul Brousse Hospital, Villejuif, France.
Adam R
No affiliation info available
Mathur S
No affiliation info available
Sherlock D
No affiliation info available

MeSH

AdolescentAdultAgedEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHumansHypertension, PortalLiver CirrhosisLiver TransplantationMaleMiddle AgedPortasystemic Shunt, SurgicalSclerotherapy

Pub Type(s)

Journal Article

Language

eng

PubMed ID

2368870

Citation

Bismuth, H, et al. "Options for Elective Treatment of Portal Hypertension in Cirrhotic Patients in the Transplantation Era." American Journal of Surgery, vol. 160, no. 1, 1990, pp. 105-10.
Bismuth H, Adam R, Mathur S, et al. Options for elective treatment of portal hypertension in cirrhotic patients in the transplantation era. Am J Surg. 1990;160(1):105-10.
Bismuth, H., Adam, R., Mathur, S., & Sherlock, D. (1990). Options for elective treatment of portal hypertension in cirrhotic patients in the transplantation era. American Journal of Surgery, 160(1), 105-10.
Bismuth H, et al. Options for Elective Treatment of Portal Hypertension in Cirrhotic Patients in the Transplantation Era. Am J Surg. 1990;160(1):105-10. PubMed PMID: 2368870.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Options for elective treatment of portal hypertension in cirrhotic patients in the transplantation era. AU - Bismuth,H, AU - Adam,R, AU - Mathur,S, AU - Sherlock,D, PY - 1990/7/1/pubmed PY - 1990/7/1/medline PY - 1990/7/1/entrez SP - 105 EP - 10 JF - American journal of surgery JO - Am J Surg VL - 160 IS - 1 N2 - We review herein our experience in the management of bleeding esophageal varices in cirrhotic patients and consider our findings in light of the dramatic changes in the treatment of cirrhosis resulting from the more widespread use of orthotopic liver transplantation (OLT). It does not seem realistic, at present, to propose OLT as the only effective treatment of variceal bleeding for a variety of reasons, and there remains a large group of patients who are noncompliant or unsuitable for liver transplantation. We propose that initial bleeding be controlled by endoscopic sclerotherapy, thereby allowing careful evaluation to be made electively. Grade A patients appear to be managed best by a reduced-size portacaval shunt (RPS) with prospects of good survival and few complications. Grade B patients can be managed by either sclerotherapy, RPS, or OLT, depending upon individual circumstances. Grade C patients are best managed by liver transplantation, again with excellent survival. In those grade C patients not deemed suitable for OLT (especially alcoholic patients), long-term endoscopic sclerotherapy is the best option. Changes in patient status may sometimes require revision of the treatment decision. SN - 0002-9610 UR - https://www.unboundmedicine.com/medline/citation/2368870/Options_for_elective_treatment_of_portal_hypertension_in_cirrhotic_patients_in_the_transplantation_era_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9610(05)80878-5 DB - PRIME DP - Unbound Medicine ER -