Hassab operation with intraoperative endoscopic injection sclerotherapy ("Hassab-EIS") for esophagogastric varices: with an autopsied case after excessive gastric vascular damage

Abstract

Background/aims: Endoscopic injection sclerotherapy (EIS) does not always treat advanced esophagogastric varices completely. Moreover, it may cause deterioration of gastric varices and may result in gastric hemorrhages. We would like to emphasize a combination treatment of the obliteration therapy of intramural varices by EIS and the transabdominal devascularization with splenectomy by Hassab's operation for such advanced esophagogastric varices. The purpose of this study is to develop an effective, less-painful procedure, having the fewest operational risks and a minimum number of treatment days.

Materials and methods: We tried both therapies simultaneously (Hassab+EIS) on four patients with esophagogastric varices.

Results: Excessive vessel damage occurred in one patient which resulted in postoperative bleeding. He subsequently fell into sepsis/DIC and eventually died on the 9th POD. The three other patients are doing well and required less hospitalization time and a fewer number of additional EIS treatments than the esophageal transection group or the Hassab's operation group.

Conclusion: From the reconsideration of the autopsied case, it is important to limit the distribution of the sclerosant only in the varicose veins of the lower esophagus and the upper stomach.