Gastric Mucosal Lesions in Cases of Nonshunting Procedures for Esophageal Varices

Gastric mucosal lesions in 74 patients with esophageal varices for whom the nonshunting procedure was given in our institute from 1973 to 1983 were studied. Out of 9 patients of operative death, the direct cause of death in 2 patients was acute gastric mucosal lesion (AGML), and both patients belonged to Child C according to Child's Classification. The rate of complication of gastric mucosal lesion before operation was 42%, while it was 64% after operation, and all cases were complicated with liver cirrhosis. Among 31 cases in whom the condition before and after operation in the same case was compared, and found that gastric mucosal lesions were aggravated after operation in 12 patients (39%). The rate of post-operative aggravation of gastric mucosal lesions classified by the surgical formula was 18.8% of esophageal transection, and in comparison Hassab's operation was a high as 61.1%. In patients with liver cirrhosis, the defensive factors of the gastric mucosa had been reduced. Hassab's operation which changes the gastric mucosal blood flow by periesophago-gastric devascularization has a high possibility of aggravating gastric mucosal lesions.