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J Gastroenterol Hepatol 1997 Aug;12(8):582-584
Effect of shunt surgery on spleen size, portal pressure and esophageal varices
in patients with non-cirrhotic portal hypertension.
Sharma BC, Singh RP, Chawla YK, Narasimhan KL, Rao KL, Mitra SK, Dilawari JB
Shunt surgery is considered to be the treatment of choice in patients with non-cirrhotic
portal hypertension. There is little data on the effect of side-to-side lieno-renal
(SSLR) shunt on oesophageal variceal size, splenic size and splenic pulp pressure
(SPP) in patents with non-cirrhotic portal hypertension. We evaluated pre- and
postoperatively endoscopic grading of varices, splenic size and SPP for predicting
shunt patency in 86 patients with non-cirrhotic portal hypertension: 56 with
extrahepatic portal venous obstruction (EHPVO) and 30 with non-cirrhotic portal
fibrosis (NCPF). The EHPVO patients with patent shunts (n = 47) showed significant
reduction in SPP (pre-operative 43.56 +/- 7.9 vs postoperative 29.96 +/- 0.5
vs 0.92 +/- 0.8). Patients with blocked shunt (n = 9) did not show significant
reduction in SPP and varices grades. However, there was reduction in spleen
size (8.6 +/- 3.0 vs 6.3 +/- 4.3). In the NCPF group, 28 had patent shunts and
showed significant reduction in SPP (46.3 +/- 13.5 vs 33.8 +/- 7.6 cm of saline),
splenic size (9.1 +/- 3.3 vs 6.8 +/- 4.6 cm below costal margin) and varices
grades (2.8 +/- 0.7 vs 1.05 +/- 0.96). As only two patients with NCPF had blocked
shunts, no statistical comparison between patients with patent and patients
with blocked shunts could be done. In conclusion, following SSLR, there is a
significant reduction in SPP and varices grades in patients with patent shunts.
Endoscopic grading of varices can be used to predict shunt patency. However,
spleen size is not a good criteria for predicting shunt patency.
PMID: 9304510, UI: 97449494
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