{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T16:10:03Z","timestamp":1727539803438},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[1994,7,1]],"date-time":"1994-07-01T00:00:00Z","timestamp":773020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1994,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Continued haemorrhage from oesophageal varices despite adequate injection sclerotherapy and tamponade has a high mortality rate. Such patients are usually referred for surgery. Over a 10-year period, 30 patients (21 men and nine women of median age 52 (range 21\u201370) years) with acute variceal haemorrhage uncontrolled by initial treatment underwent early emergency oesophageal transection. Portal hypertension was caused by alcoholic cirrhosis in 22 patients; other forms of cirrhosis were present in seven and portal vein thrombosis in one. Hepatic function immediately before operation was Pugh grade A in two patients, B in six and C in 22. Deterioration between admission and transection from grade A to B occurred in one patient and from B to C in five. Oesophageal transection stopped variceal haemorrhage in 29 of the 30 patients. Rebleeding from gastric varices within 35 days of surgery occurred in five patients. Postoperative haemorrhage also occurred from perioesophageal vessels (two patients), a gastrotomy (one) and oesophageal ulceration (two). Hepatic failure developed in seven patients, renal failure in five and both hepatic and renal failure in four. Mortality at 30 days occurred in neither of the two patients with liver function of grade A, in one of six of grade B and in 18 of 22 of grade C. The overall 30-day mortality rate was thus 63 per cent. Mortality was related to the preoperative Pugh grade (hazard ratio 3\u00b795 per grade; P = 0\u00b7013) and preoperative blood transfusion (hazard ratio 1\u00b737 per unit; P = 0\u00b7035). Four of six patients with grade B liver function died within 3 months and 21 of 22 with grade C disease within 1 year. Oesophageal transection is effective at stopping variceal bleeding but does not modify the underlying disease. Caution is urged for patients with grade C hepatocellular impairment proceeding to acute oesophageal transection after initial sclerotherapy. Such patients may benefit more from treatment with somatostatin or an intrahepatic portasystemic stent shunt while awaiting definitive therapy.<\/jats:p>","DOI":"10.1002\/bjs.1800810721","type":"journal-article","created":{"date-parts":[[2007,3,3]],"date-time":"2007-03-03T20:26:35Z","timestamp":1172953595000},"page":"992-995","source":"Crossref","is-referenced-by-count":11,"title":["Emergency oesophageal transection for uncontrolled variceal haemorrhage"],"prefix":"10.1093","volume":"81","author":[{"given":"P D","family":"Willson","sequence":"first","affiliation":[{"name":"Gastrointestinal Unit, Charing Cross Hospital , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Kunkler","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Charing Cross and Westminster Medical School , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S D","family":"Blair","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit, Charing Cross Hospital , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K W","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit, Charing Cross Hospital , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1994,7,1]]},"reference":[{"key":"2024092815352024700_bib1","first-page":"34","article-title":"Limitations of multiple injection sclerotherapy sessions for acute variceal bleeding","volume":"70","author":"Bornman","year":"1986","journal-title":"S Afr Med J"},{"key":"2024092815352024700_bib2","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/S0016-5085(19)32736-2","article-title":"A controlled study of the therapeutic portacaval shunt","volume":"67","author":"Resnick","year":"1974","journal-title":"Gastroenterology"},{"key":"2024092815352024700_bib3","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/S0140-6736(76)92775-6","article-title":"A controlled study of therapeutic portacaval shunt in alcoholic cirrhosis","volume":"i","author":"Rueff","year":"1976","journal-title":"Lancet"},{"key":"2024092815352024700_bib4","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1002\/bjs.1800760115","article-title":"Variceal haemorrhage after failed injection sclerotherapy: the role of emergency oesophageal transection","volume":"76","author":"Jenkins","year":"1989","journal-title":"Br J Surg"},{"key":"2024092815352024700_bib5","doi-asserted-by":"crossref","first-page":"646","DOI":"10.1002\/bjs.1800600817","article-title":"Transection of the oesophagus for bleeding oesophageal varices","volume":"60","author":"Pugh","year":"1973","journal-title":"Br J Surg"},{"key":"2024092815352024700_bib6","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1097\/00000658-198110000-00015","article-title":"Acute bleeding varices: a five-year prospective evaluation of tamponade and sclerotherapy","volume":"194","author":"Terblanche","year":"1981","journal-title":"Ann Surg"},{"key":"2024092815352024700_bib7","first-page":"239","article-title":"A prospective evaluation of injection sclerotherapy in the treatment of acute bleeding from esophageal varices","volume":"85","author":"Terblanche","year":"1979","journal-title":"Surgery"},{"key":"2024092815352024700_bib8","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/BF00591393","article-title":"Immediate endoscopic sclerosis of bleeding esophageal varices. 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