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Schistosomal versus nonschistosomal variceal bleeders. Do they respond differently to selective shunt (DSRS)?
Ann Surg. 1989 Apr; 209(4):489-500.AnnS

Abstract

The distal splenorenal shunt (DSRS) was performed in 125 consecutive variceal bleeders. To date, no patients have been lost to follow-up (mean of 79 +/- 20 months). Liver pathology was documented in 85 patients: 45 patients had schistosomal hepatic fibrosis, 17 had nonalcoholic cirrhosis, and 23 had mixed pattern (hepatic fibrosis and cirrhosis). The preoperative data base for these three groups was matched (p greater than 0.05), with a mean follow-up of 79 +/- 20, 70 +/- 14, and 77 +/- 22 months for each population, respectively. The results showed low operative mortality (4.8%), high cumulative patency rate (94.8%) and low recurrent variceal hemorrhage (5.6%). The biochemical data showed significant increase in serum bilirubin (p less than 0.001) and aspartate transaminase (AST) (p less than 0.05) in the nonschistosomal patients. Chronic hyperbilirubinemia was found in 33% of the schistosomal group. Prograde portal perfusion was detected in 94% of the patients, with development of collaterals in 91%. The angiographic pattern of these collaterals was 50% pancreatic, 45% gastric, and 26% colosplenic. Patients with mixed liver disease had a high incidence of Grade III portal perfusion (57%) and more common pancreatic and gastric collaterals (71%). The cumulative survival for all patients was 74.1%, with hepatic cell failure being the leading cause of death (13 patients, 50% of all deaths). The schistosomal patients had a 91.6% incidence, whereas the cirrhotic and mixed groups had survival rates of 75.6% and 65.2%, respectively. Also, of a 15% total incidence of encephalopathy, 4.4% was related to the schistosomal patients, 23.5% to the cirrhotics, and 21.7% to the mixed population. Statistically, the survival rate was significantly better (p less than 0.05) and encephalopathy was significantly lower (p less than 0.05) in the schistosomal population. In conclusion, this data shows that: 1) DSRS has a high patency rate and a low variceal hemorrhage recurrence rate; 2) it maintains some degree of portal perfusion in patients with different nonalcoholic liver diseases, despite development of collaterals; and 3) the schistosomal patients have a better survival rate, with a low incidence of encephalopathy after DSRS, compared with the cirrhotic and mixed populations.

Authors+Show Affiliations

Department of Surgery, Mansoura University School of Medicine, Egypt.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

2784663

Citation

Ezzat, F A., et al. "Schistosomal Versus Nonschistosomal Variceal Bleeders. Do They Respond Differently to Selective Shunt (DSRS)?" Annals of Surgery, vol. 209, no. 4, 1989, pp. 489-500.
Ezzat FA, Abu-Elmagd KM, Sultan AA, et al. Schistosomal versus nonschistosomal variceal bleeders. Do they respond differently to selective shunt (DSRS)? Ann Surg. 1989;209(4):489-500.
Ezzat, F. A., Abu-Elmagd, K. M., Sultan, A. A., Aly, M. A., Fathy, O. M., Bahgat, O. O., el-Fiky, A. M., el-Barbary, M. H., & Mashhoor, N. (1989). Schistosomal versus nonschistosomal variceal bleeders. Do they respond differently to selective shunt (DSRS)? Annals of Surgery, 209(4), 489-500.
Ezzat FA, et al. Schistosomal Versus Nonschistosomal Variceal Bleeders. Do They Respond Differently to Selective Shunt (DSRS). Ann Surg. 1989;209(4):489-500. PubMed PMID: 2784663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Schistosomal versus nonschistosomal variceal bleeders. Do they respond differently to selective shunt (DSRS)? AU - Ezzat,F A, AU - Abu-Elmagd,K M, AU - Sultan,A A, AU - Aly,M A, AU - Fathy,O M, AU - Bahgat,O O, AU - el-Fiky,A M, AU - el-Barbary,M H, AU - Mashhoor,N, PY - 1989/4/1/pubmed PY - 1989/4/1/medline PY - 1989/4/1/entrez SP - 489 EP - 500 JF - Annals of surgery JO - Ann. Surg. VL - 209 IS - 4 N2 - The distal splenorenal shunt (DSRS) was performed in 125 consecutive variceal bleeders. To date, no patients have been lost to follow-up (mean of 79 +/- 20 months). Liver pathology was documented in 85 patients: 45 patients had schistosomal hepatic fibrosis, 17 had nonalcoholic cirrhosis, and 23 had mixed pattern (hepatic fibrosis and cirrhosis). The preoperative data base for these three groups was matched (p greater than 0.05), with a mean follow-up of 79 +/- 20, 70 +/- 14, and 77 +/- 22 months for each population, respectively. The results showed low operative mortality (4.8%), high cumulative patency rate (94.8%) and low recurrent variceal hemorrhage (5.6%). The biochemical data showed significant increase in serum bilirubin (p less than 0.001) and aspartate transaminase (AST) (p less than 0.05) in the nonschistosomal patients. Chronic hyperbilirubinemia was found in 33% of the schistosomal group. Prograde portal perfusion was detected in 94% of the patients, with development of collaterals in 91%. The angiographic pattern of these collaterals was 50% pancreatic, 45% gastric, and 26% colosplenic. Patients with mixed liver disease had a high incidence of Grade III portal perfusion (57%) and more common pancreatic and gastric collaterals (71%). The cumulative survival for all patients was 74.1%, with hepatic cell failure being the leading cause of death (13 patients, 50% of all deaths). The schistosomal patients had a 91.6% incidence, whereas the cirrhotic and mixed groups had survival rates of 75.6% and 65.2%, respectively. Also, of a 15% total incidence of encephalopathy, 4.4% was related to the schistosomal patients, 23.5% to the cirrhotics, and 21.7% to the mixed population. Statistically, the survival rate was significantly better (p less than 0.05) and encephalopathy was significantly lower (p less than 0.05) in the schistosomal population. In conclusion, this data shows that: 1) DSRS has a high patency rate and a low variceal hemorrhage recurrence rate; 2) it maintains some degree of portal perfusion in patients with different nonalcoholic liver diseases, despite development of collaterals; and 3) the schistosomal patients have a better survival rate, with a low incidence of encephalopathy after DSRS, compared with the cirrhotic and mixed populations. SN - 0003-4932 UR - https://www.unboundmedicine.com/medline/citation/2784663/Schistosomal_versus_nonschistosomal_variceal_bleeders__Do_they_respond_differently_to_selective_shunt__DSRS_ L2 - http://Insights.ovid.com/pubmed?pmid=2784663 DB - PRIME DP - Unbound Medicine ER -