Endovascular diagnosis and treatment of profuse esophageal bleeding in patients with portal hypertension.

BACKGROUND/AIMS: In this study the possible choices and the most effective tactics of endovascular treatment of bleeding from esophageal varicosities in patients with portal hypertension were identified.

METHODOLOGY

Results of angiographic examination and endovascular interventions in 121 patients with portal hypertension complicated by esophageal bleeding were analysed in this study. Embolization of esophageal varicosities in the first group of patients (N(17) was conducted as emergency intervention within 3-4 hours. Endovascular occlusion of bleeding vessels in the second group (N(70) was conducted following balloon tamponade of varicosities and drug therapy of homeostasis impairment within 3-4 days. The treatment in the third group (N(34) was adjusted by intra-portal infusion of drugs.

RESULTS

Embolization of esophageal varicosities without correction of homeostasis impairment due to bleeding had a lethal outcome in 52.9% of patients. Three to four days after the interventions had been, 13.5% of patients died. Combination of embolization of esophageal and gastric varicosities with intra-portal infusion of drugs was accompanied by lethal outcome in 8.8% of patients.

CONCLUSIONS

Success of endovascular treatment of esophageal bleeding in patients with portal hypertension depends on adequate pre-embolization preparation, selection of tactics, volume and terms of its filfilment as well as systematic stage-by-stage corrective endovascular interventions in distant terms.