Long-Term Efficacy of Transvenous Obliteration of Porto-Systemic Shunt (TOPS) Therapy for Solitary Gastric Varices

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We have evaluated the long-term efficacy of a transvenous obliteration of porto-systemic shunt (TOPS) therapy using a self-retaining catheter for solitary gastric varices (GS), and the results are compared with those obtained by endoscopic injection sclerotherapy (EIS). Twenty patients with liver cirrhosis, not complicated with hepatocellular carcinoma, were treated with TOPS and 15 were treated with EIS as a control. Emergency cases were excluded. Mean observation periods were 36.1 (maximum 76) months and 23.7 (maximum 42) months for the TOPS group and the EIS group, respectively. The recurrence rate of GS was 0% for the TOPS group, and was 22% and 43% at 24 months period and 41 months during the observation, respectively, for the EIS group. The difference was highly significant. The recurrence rate for esophageal varices after TOPS was not significantly different from that after EIS (26% at 36 months vs 38% at 36 months). However, the rate of rebleeding was significantly lower in the TOPS group than in the EIS group (5% at 76 months vs 64% at 44 months). The mortality rate during the observation periods was not different between the two groups. These observations indicate that although TOPS doesn't significantly change a survival rate, it can improve the quality of life of patients with solitary gastric varix.
The Japan Society for Portal Hypertensionの論文