Use of the EEA stapling instrument for control of bleeding esophageal varices

Transection of the esophagus with the EEA stapling device (United States Surgical Corp.) has been used to treat 20 patients with bleeding esophageal varices. Their ages ranged from 38 to 73 years (mean 56.7 years). Sixteen patients (80%) had Laënnec's cirrhosis. A previous occluded portosystemic shunt was present in five patients. Based on Child's classification, there were one class A patient, 18 class C patient, and one patient who was unclassified. Five patients underwent elective operation; four survived (80%). The cases of the remaining 15 patients were treated as emergencies or semiemergencies after intensive preoperative intervention including intravenous administration of vasopressin (Pitressin) (100%), balloon tamponade in 11 (73%), and sclerotherapy in three (20%) failed to control the hemorrhage adequately. None of the patients had rebleeding from varices during the postoperative period. However, 11 of the 15 patients (73%) died. All deaths were related to liver failure, except for two patients who died of irreversible acidosis secondary to shock. Technical difficulty was encountered six times with use of the stapling device, resulting in three perforations of the esophagus, which were recognized and repaired at the time. No deaths were attributed to this complication. Of the eight patients who survived the early postoperative period, three have since died--two of variceal hemorrhage and the other of hepatic failure. Two others have had recurrent variceal hemorrhage controlled by sclerotherapy. The duration of follow-up ranges from 10 to 60 months (mean 31 months). Transection of the esophagus with the EEA stapling device for acute variceal hemorrhage is associated with an excessively high mortality rate despite the fact that it controls variceal hemorrhage. It appears to be of value when used on an elective basis for selected patients who cannot benefit from other modes of treatment.