[Hemodynamics and treatment based on endoscopic classification of esophago-gastric varices]

The relationship between endoscopic findings and hemodynamics was studied in 262 patients. The endoscopic findings were classified into 3 groups; 1) Type 1: case with esophageal varices. 2) Type 2: case with esophago-cardiac varices. 3) Type 3: case with fundic varices. The hemodynamics were examined using late phase venography after conventional abdominal angiography. The blood vessels of type 1 resembled those of type 2, and 72% of the cardiac varices were connected with esophageal varices. On the other hand, the blood vessels of type 3 were completely different from those of type 1 and type 2, and 84% of the fundic varices were connected with large gastro-renal shunts. From these results, I have been applying endoscopic in injection sclerotherapy for types 1 and 2, and Hassab's operation for type 3. The rates of hemostasis were 100%, 93% and 100% in types 1, 2 and 3, respectively. The rates of disappearance of the varices after treatment were 78.7%, 87% and 100% in types 1, 2 and 3, respectively. It is concluded that good therapeutic results can be obtained when an appropriate therapeutic method is selected. Treatment should be based on the hemodynamics associated with the endoscopic findings of esophago-gastric varices.