Devascularization procedures can help manage critical situations of variceal bleeding
A devascularization procedure aims to control bleeding from varices at the junction between the esophagus and stomach, towards the lower end of the esophagus.
Varices are enlarged veins that occur due to portal hypertension. Ideally, esophagogastric devascularization procedures control bleeding varices by permanently destroying the vessels in the esophagogastric region.
When do doctors recommend a devascularization procedure?
Portal hypertension, defined as blood pressure higher than 5 mmHg in the portal veins, is caused by cirrhosis or liver scarring.
A portal vein carries blood to the liver from the spleen, stomach, pancreas, and intestines. A portal pressure of 10 mmHg or higher is associated with an increased risk of gastroesophageal varices. Gastroesophageal varices are found in approximately 50% people with cirrhosis.
Doctors recommend a devascularization procedure when nonoperative therapies fail to prevent bleeding from the gastroesophageal varices. These therapies include:
- Medications
- Beta-blockers
- Vasopressin
- Somatostatin
- Endoscopic procedures
- Endoscopic variceal ligation
- Sclerotherapy
- Glue injection
- Interventional radiologic procedures
- Balloon-occluded retrograde transvenous obliteration
- Transjugular intrahepatic portosystemic shunt
Devascularization procedures are rarely the treatment of choice in emergencies. However, when nonsurgical procedures fail and radiologic therapies cannot be performed, devascularization procedures can help manage critical situations of variceal bleeding.
What happens before a devascularization procedure?
Before the procedure, your doctor will order tests, including a complete blood count, comprehensive metabolic panel, coagulation studies, liver function tests, and blood type.
A day before the surgery, your doctor may arrange blood units for transfusion. A tube called a nasogastric tube is inserted through the nose, down the throat and esophagus, and into the stomach. It can be used to give drugs, liquids, and liquid food or used to remove substances from the stomach.
What happens after a devascularization procedure?
You may be monitored in a surgical intensive care unit immediately after the operation. You may be kept on only intravenous fluids and not allowed to eat for at least 5 days after the procedure.
About 5-7 days after the devascularization procedure, you may undergo a contrast esophagography to check if there are problems such as leakage, fistula, or narrowing at the esophageal region where the surgery was performed. Contrast esophagography involves taking a series of X-ray pictures of the esophagus after you drink a liquid containing barium sulfate. If no problems are detected, your doctor may ask you to begin drinking clear liquids. Gradually, you will be advanced to a semi-solid and then normal diet.
Your doctor may ask you to undergo another diagnostic procedure known as esophagogastroduodenoscopy (EGD) one month after the devascularization procedure. EGD involves inserting a long, thin, flexible tube (endoscope) fitted with a light and camera into your mouth that allows your doctor to examine your esophagus, stomach, and duodenum (part of your small intestine). You will be asked to have regular follow-ups with your surgeon.