Endoscope assisted surgery for the treatment of bleeding esophageal varices

In attempts to obtain complete control of bleeding esophageal varices, terminal esophago-proximal gastrectomy (TEPG) and its modification proximal gastric transection (PGT) were performed, under endoscopic assistance, in 42 patients with cirrhotic portal hypertension. Complete disappearance of varices was confirmed in all patients at surgery and 4 weeks after surgery, and this condition was maintained for up to 60 months in 15 patients of TEPG and 16 of PGT. Recurrent varices in 3 (17 per cent) TEPG and 8 (34 per cent) PGT were attributed to the advance in the liver cirrhosis in 7, hepatoma in 3 and portal vein thrombosis in 1. In 8 of 11 recurrences, type C variceal blood circulation drained into the cervical veins. Endoscopic assistance during surgical treatment for bleeding esophageal varices plays a decisive role.