Role of Endoscopy in the Treatment of Portal Hypertension Patients

Aim. To improve the results of treatment of patients with portal hypertension and bleeding from esophageal and gastric varices by improving diagnostic and treatment tactics.
Material and Methods. It was analyzed the results of treatment of 440 patients with esophageal and gastric varices. In 367 patients portal hypertension was caused by liver cirrhosis and in 73 patients – by extrahepatic portal block. Endoscopic ligation (EL) of esophageal veins is made in 114 patients, sclerotherapy – in 196 patients, endoscopic ligation of stomach veins type I – in 62 cases, sclerotherapy for stomach varices type II – in 44 patients. Splenectomy was performed in 23 patients with isolated varicose veins of the stomach fundus.
Results. Sclerotherapy is the most effective method to stop ongoing bleeding from esophageal and gastric varices among other endoscopic interventions. Delayed endoscopic ligation and sclerotherapy after primary hemostasis by tip-obturator improve the performance of techniques’ application and increase resistant hemostatic effect of sclerotherapy in esophagus from 58.3% to 72.1%, in stomach – from 30.0% to 77.8%; ligation in esophagus from 60.0% to 91.7% and in stomach was 92.9%. In the prevention of recurrent bleeding from esophageal and gastric varices routinely hemostatic effects of sclerotherapy in esophagus was 93.9%, in stomach – 100%; ligation in esophagus – 84.5%, in stomach –
91.7%. Features of the ES in the primary prevention of bleeding from varices limited to the large size of varices and development trophic complications. Endoscopic ligation has advantages in the prevention of first bleeding in esophagus and in stomach. In patients with isolated varices of the gastric fundus preferential treatment is splenectomy. Survival rate and hemostatic effect up to 3 years was 100%.

Conclusion. Presented data indicate the need for detailed diagnosis to make decision about possible endoscopic interventions for different types of varicose veins

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