Treatment Schistosomal Portal Hypertension: Efficacy of Endoscopy or Surgery
Treatment Schistosomal Portal Hypertension: Efficacy of Endoscopy or Surgery
Upper gastrointestinal bleeding (UGIB) is a major cause of morbidity and mortality in
 patients with portal hypertension secondary to schistosomiasis mansoni. Taking into account
 the endemic nature of schistosomiasis mansoni in our region and the high morbidity and
 mortality directly associated with rupture of esophageal varices and UGIB in affected
 patients, we conducted a prospective randomized trial in patients with schistosomiasis and a
 history of bleeding esophageal varices. Its purpose was to assess the efficacy of endoscopic
 treatment alone compared with the efficacy of sclerotherapy preceded by a surgical treatment:
 Esophagogastric devascularization with splenectomy (EGDS).
This was a prospective, randomized, single-center study carried out at the Department of
 Clinical and Surgical Gastroenterology of Hospital Universitário Professor Alberto Antunes,
 Universidade Federal de Alagoas (HU/UFAL). It was approved by the local Research Ethics
 Committee (protocol #98/0039-3, code 4010000-6) and all patients provided written informed
 consent prior to study enrollment. Patients who met relative criteria for exclusion received
 the current standard of care and follow-up and were analyzed as a third group in the study.

 Over a two-year period, 79 patients were recruited for elective treatment of SPH. The
 criteria for selection were: a) an established diagnosis of hepatosplenic schistosomiasis as
 the cause of portal hypertension; b) a history of UGIB secondary to rupture of esophageal
 varices, with at least 20 days having elapsed since the most recent episode of bleeding; and
 c) age between 15 and 65 years.

 The exclusion criteria were: chronic alcoholism, defined as an alcohol intake of ≥60
 g/EtOH/day in men and ≥40 g/EtOH/day in women; evidence of decompensated liver disease of
 mixed etiology or of any chronic disease that contraindicated surgery were considered
 absolute exclusion criteria; the relative criteria for exclusion were altered hemostasis
 (platelet count < 50×109/L or INR > 1.5); presence of fundal varices on endoscopy.
Inclusion Criteria:

 -  age between 15 and 65 years;

 -  an established diagnosis of hepatosplenic schistosomiasis as the cause of portal
 hypertension;

 -  a history of UGIB secondary to rupture of esophageal varices, with at least 20 days
 having elapsed since the most recent episode of bleeding.

 Exclusion Criteria:

 -  Chronic alcoholism, defined as an alcohol intake of ≥60 g/EtOH/day in men and ≥40
 g/EtOH/day in women;

 -  evidence of decompensated liver disease of mixed etiology or of any chronic disease
 that contraindicated surgery were considered absolute exclusion criteria;

 -  the relative criteria for exclusion were altered hemostasis (platelet count < 50×109/L
 or INR > 1.5);

 -  presence of fundal varices on endoscopy.