Emergency Portacaval Shunt Treatment for Bleeding Esophageal Varices: Prospective Study in Unselected Patients With Alcoholic Cirrhosis

A prospective evaluation of emergency portacaval shunt has been conducted during a ten-year period in 115 unselected consecutive patients with alcoholic cirrhosis and bleeding esophageal varices. An extensive diagnostic evaluation was completed within seven hours of hospital admission and the shunt operation was undertaken within a mean 8.1 hours. Follow-up was conducted in a special clinic, and the current status of 98.3% of the patients is known. Eighty-two percent of the patients had jaundice, ascites, or encephalopathy alone or in combination on admission. Contrary to recent proposals, patients with the highest portal perfusion pressure and the largest hepatopetal portal blood flow had the highest survival rate, and those who sustained the smallest portal flow diversion from the shunt had the lowest survival rate. The operative survival rate was 48%, the predicted seven-year survival rate was 30%, and the actual seven-year survival rate of 40 patients who were operated on seven or more years ago was 42.5%. In comparisons with our previous prospective studies, emergency portacaval shunt resulted in a significantly greater long-term survival rate than either emergency medical therapy or emergency varix ligation, followed by elective shunt.