[Etiology and hemodynamics of esophago-gastric varices]

The hemodynamics of the portal area, particularly of the left gastric vein in cases of esophago-gastric varices with portal hypertension have revealed that only one-third are featuring hepatofugal collateral flow (Type I), while hepatopetal and/or to and fro flow (Type II) forms make up about two-thirds. Furthermore, regarding the supply of blood to the varices, in all cases a contribution of arterial blood inflowing through the left gastric artery to the upper part of the stomach was found. Therefore, concerning the etiology of varices other than that due to hepatofugal collaterales, a hyperdynamic state of the upper part of the stomach area has been considered as an important factor. With regard to the micro-circulation of the gastric wall, it was proved that the hyperdynamic state was caused by an increase in submucosal arterio-venous anastomoses, and this was concluded to be directly responsible for the etiology of the varices. Therefore, the appropriate therapeutic approach to varices should as the rule be based on interruption both of hepatofugal collaterales and arterial flow, or the drainage of the hypertensive state of the local venous system.