Endoscope assisted terminal esophago-proximal gastrectomy for the treatment of esophageal varices in portal hypertension--late results and an analysis of the mechanisms of recurrence.

Endoscopic assistance during terminal esophago-proximal gastrectomy (TEPG) was performed in 86 patients with portal hypertension to confirm the complete disappearance of esophageal varices and eradicate any remnants. The utility of endoscope assisted surgery (EAS), and the mechanisms of recurrent varices were thereby analyzed. Some postoperative recurrence is unavoidable after direct attack surgery as portal hypertension is often still present. Nevertheless, satisfactory disappearance was maintained in 56 cases (65 per cent) from 2 months to 9 years of follow up. Recurrent varices were observed in the other 30 cases, the causes presumably being: atrophy of the liver in 15 cases, thrombus formation in the portal vein in 10 cases, and various other causes in 5 cases; indicating increased resistance on the portal blood flow as a uniform mechanism. The episodes of rebleeding due to recurrent varices or staple ulceration in 8 cases were successfully treated by endoscopic injection sclerotherapy and medication. Actual proof of the disappearance of varices through EAS and an analysis of the mechanisms of recurrence are essential for improving the surgical techniques and treatment in cases of recurrent esophageal varices.