Portasystemic Shunting Remains the Procedure of Choice for Control of Variceal Hemorrhage

We reviewed 108 patients (50% Child's C) who had been admitted with acutely bleeding esophageal varices to compare the efficacy of operative (portasystemic shunt) therapy with the reported efficacy of sclerotherapy. In the patients with shunts the early mortality (preoperative plus operative) was 13% and late mortality was 23%. Survival at five years was 50%. Recurrent variceal bleeding was seen in 4% of the patients. Procedure-related mortality and variceal rebleeding rates for the shunt group were respectively 50% and 8% of that reported for sclerotherapy. Variceal rebleeding in the sclerotherapy group required approximately 7 units of blood per episode. We concluded that immediate attempts at control of hemorrhage followed by portasystemic shunting remains the therapy of choice for these patients.