PORTAL PRESSURE DECREASE AFTER ESOPHAGOGASTRIC DEVASCULARIZATION AND SPLENECTOMY IN SCHISTOSOMIASIS: LONG-TERM...

Area of Science:

• Hepatology
• Gastroenterology
• Infectious Diseases

Background:

• Schistosomiasis affects millions, causing hepatosplenic disease with portal hypertension and esophageal varices.
• Esophageal varices bleeding is a major complication, often treated with esophagogastric devascularization and splenectomy.
• Combined surgical and postoperative endoscopic treatment is frequently reported to yield better outcomes.

Purpose of the Study:

• To compare intraoperative portal pressure decrease, esophageal varices behavior, and rebleeding rates.
• To evaluate long-term outcomes in patients undergoing combined surgical and endoscopic therapy for schistosomiasis-induced portal hypertension.

Main Methods:

• Retrospective study of 36 schistosomiasis patients with prior esophageal varices bleeding.
• Patients underwent esophagogastric devascularization, splenectomy, and postoperative endoscopic treatment.
• Stratification into two groups based on intraoperative portal pressure decrease (<30% vs. >30%).

Main Results:

• No significant difference in varices behavior was observed between groups based on portal pressure fall.
• Bleeding recurrence was not significantly different, despite being more frequent in the lower portal pressure group.
• All patients received postoperative endoscopic treatment.

Conclusions:

• Esophageal varices banding, not portal pressure reduction, is suggested as the primary factor for successful combined therapy.
• This highlights the importance of endoscopic intervention in managing portal hypertension complications in schistosomiasis.
• Further studies are recommended to validate the role of endoscopic treatment versus portal pressure changes.