Selective Variceal Decompression: Current Status

[摘要] Since its introduction into clinical practice in 1967, selective variceal decompression by means of a distalsplenorenal shunt (DSRS) has become one of the more commonly performed portal-systemic shuntingprocedures in the treatment of variceal hemorrhage throughout the world. In addition to selectivedecompression of gastroesophageal varices, the DSRS provides the advantages of preservation of portalperfusion of the liver and maintenance of intestinal venous hypertension. Many large, uncontrolledseries and the majority of controlled randomized studies have demonstrated a lower incidence ofencephalopathy after the DSRS than after nonselective shunt procedures. A secondary advantage of theDSRS is that the hepatic hilum is avoided, thus making subsequent liver transplantation a lessformidable procedure. None of the studies have shown an advantage to this shunt with respect to longtermsurvival in patients with alcoholic cirrhosis. However, some of the large, uncontrolled series haveshown that survival is significantly improved in patients with non-alcoholic cirrhosis compared tononselective shunt procedures in the same population. Controlled trials comparing the DSRS toendoscopic sclerotherapy have shown that chronic endoscopic variceal sclerosis is an appropriate initialtherapy for most patients as long as shunt surgery is readily available if sclerotherapy fails.

[学科分类] 过敏症与临床免疫学