Nonsurgical intrahepatic portacaval shunt; a utopian dream or an approaching reality?

A prospective study was undertaken to assess the results of embolization of esophageal varices by the transjugular approach, in 83 patients with advanced cirrhosis (65 p. 100 Child's class C) admitted with severe bleeding (mean of 10 units of blood per patient). Embolization was successfully completed in 65 patients (78 p. 100) and complete obliteration was achieved in 50 (60 p. 100). Twenty‐nine procedures were performed on actively bleeding patients. Cessation of bleeding was observed in 22 (76 p. 100). Excluding the 5 patients in whom embolization could not be achieved, the success rate was 92 p. 100. Embolization was attempted as an elective procedure in 54 patients who were not actively bleeding. Recurrent hemorrhage occurred in 18 patients (33 p. 100) during the first month of follow‐up. Finally, 38 patients rebled and and 57 died. No accident could be ascribed to the procedure. It is concluded that: (a) the transjugular approach proved to be safe in actively bleeding patients with severe cirrhosis; (b) variceal obliteration effectively controlled active bleeding. The efficacy of this procedure was limited in time. The use of embolization is further hindered by a consistent failure rate and by the development of new therapeutic modalities, such as sclerotherapy.