BACKGROUND: The role of gastroesophageal devascularization (Sugiura-rype procedures) for the treatment of @entity548 remains controversial. Although Japanese series reported favorable longterm results, the technique has nor been widely accepted in the Western Hemisphere because of a high postoperative morbidity and mortality. The reasons for the different outcomes are unclear. In a multidisciplinary team approach we developed a therapeutic algorithm for @entity1 with recurrent @entity548 . STUDY DESIGN: The Sugiura procedure was offered only to @entity1 with well-preserved liver function ( @entity1 A or @entity1 B @entity82 without chronic @entity843 ) who were not candidates for distal splenorenal shunt, transhepatic porto-systemic shunt, or liver transplantation. RESULTS: Fifteen @entity1 with recurrent @entity548 underwent a modified Sugiura procedure between September 1994 and September 1997. All but one @entity1 (operative mortality 7%) are alive after a median followup of 4 years. Recurrent @entity548 developed in one @entity1 ; esophageal strictures, which were successfully treated by endoscopic dilatation, developed in three @entity1 ; and one @entity1 experienced mild @entity75 . Major complications were noted only in @entity1 with @entity409 ( @entity1 B @entity82 ) or when the modified Sugiura was performed in an emergency setting. The presence of @entity82 or the cause of portal @entity101 had no significant impact on the complication rate. CONCLUSIONS: This series was performed during the last decade when all modern therapeutic options for @entity548 were available. Our results indicate that the modified Sugiura procedure is an effective rescue therapy in @entity1 who are not candidates for selective shunts, transhepatic porto-systemic shunt, or transplantation. Emergency settings and decreased liver function are associated with an increased morbidity.

Current indication of a modified Sugiura procedure in the management of XXXX .

@entity1 :: ('9606', 'Species') :: ['Child', 'patients', 'patient'] @entity82 :: ('MESH:D005355', 'Disease') :: ['cirrhosis'] @entity101 :: ('MESH:D006973', 'Disease') :: ['hypertension'] @entity548 :: ('MESH:D006470', 'Disease') :: ['variceal bleeding'] @entity75 :: ('MESH:D001927', 'Disease') :: ['encephalopathy'] @entity843 :: ('MESH:D001201', 'Disease') :: ['ascites'] @entity409 :: ('MESH:D008107', 'Disease') :: ['impaired liver function']
@entity548 :: (MESH:D006470,Disease) :: ['variceal bleeding']
