What happens to esophageal varices after transection and devascularization?
In 14 patients who underwent endoscopic examination after esophageal transection and proximal gastric devascularization, varices disappeared in seven patients, were reduced in diameter or number in six patients, and were unchanged in one patient. No varices were present in any patient within 1 cm of the stapled anastomosis, and Doppler studies showed no flow in residual varices. During a mean follow-up of 20 months (range: 6 to 44 months), varices recurred in three patients and enlarged in five others. This study suggests that variceal obliteration, a reduction in variceal diameter, the removal of the bleeding zone in the esophagus, and undetectable blood flow in residual varices all contribute to the prevention of variceal rebleeding; although these changes are not always permanent, the return to the preoperative state may take many years.
