Therapeutic esophagoscopy based on a portal and preportal block in hemorrhaging varices of the esophagus and portal hypertension

: Parallel with the hitherto known methods of treatment of bleeding esophageal varicosities in portal hypertension with Seinkstaken-Blackmore's probe and by surgical approaches for controlling the hemorrhage from ruptured esophageal varicosities, such as Cryle's and Linton's operations, azigoportal deconnection by Tanner's technique, splenectomy, omentohepatoplexy, Sugiura's operation, esophagus ligation by the method of Fosschulte and V. Mateev (1983), the authors apply the method of transendoscopic sclerosification of bleeding varicosities in adults and children with cirrhosis of the liver and prehepatic block. The indications and contraindications of the method and the etiologic factors underlying portal and preportal block in adults and children (in adults--cirrhosis of the liver, in children--mostly preportal block secondary to portal vein thrombosis dating back to early childhood after exchange transfusion through the umbilical vein) are discussed. Of 11 sclerosified children 3 to 14 years of age, 10 are still alive (100 per cent survival of living patients). For the period 1985-1990 a total of 60 adult patients with bleeding ulcers were sclerosified and resclerosified. Hemostasis attempted in 11 patients provided successful obliteration in 42 per cent; endoscopic failure--in 15 patients (57.69 per cent). Seven patients were operated, 5 of them died. Fourty-off of 53 nonoperated patients died. Overall case fatality rate was 78.33 per cent, operative case fatality rate--71.42 per cent. Fifteen of the deceased nonoperated patients died of uncontrollable persistent bleeding, 27 of severe hepatic failure, progressive jaundice, ascites hepatorenal insufficiency and hepatargia.(ABSTRACT TRUNCATED AT 250 WORDS)