Development of therapy for esophageal varices:medical splenectomy and formation of intrahepatic shunt

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Esophageal verices is one of major causes of death in patients with portal hypertension such as liver cirrhosis, idiopathic portal hypertension,hepatocellular carcinoma stc.An operation consisting of esophageal transection and splenectomy is the best treatment for esophageal varices but it cannot be applied to patients with poor hepatic functional reserve.In these patients percutaneous transhepatic obliteration of esophageal varices and endoscopic sclerotherapy of esophageal verices have been performed.In this study,to develop a better medical treatment for esophageal varices,we studied portal hemodynamics in patients with liver cirrhosis and those with idiopathic portal hypertension, and in portal hypertensive dogs which we made.We could demonstrate that portal venous inflow (blood flow into the portal vein system)was significantly increased in patients with liver cirrhosis and those with idiopathic portal hypertension as well as in portal hyertensive dogs compared with their controls(normal subjects and nomal dofs).We further evaluated the effects of elective endoscopic sclerotherapy in comparison with elective percutaneous transhepatic obliteration of esophageal varices in patients with liver cirrhosis and esophageal varices.We could demonstrate that elective endoscopic intravariceal sclerotherapy is superior to elective percutaneoous transhepatic obliteration of esophageal verices in the prevention of recurrent variceal hemorrhage and mortality in nonalcholic cirrhosis.