Course of Esophageal Varices in Cirrhosis, in the Absence of Portal Decompression

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Abstract
Two hundred fifty-six histologically proved adult cirrhotics were examined esophagoscopically for varices 2 or more times, at variable intervals up to 10 yr. The average span was 15.3 months/ patient, with 2.8 esophagoscopic examinations/patient. The patients meanwhile were under medical treatment, in and out of the hospital, with emphasis on abstinence from alcohol and optimal nutrition. A great deal of spontaneous variation in variceal size and distribution was found, without clearly recognizable change in the state of the liver disease. Between first and final esophagoscopic examination there was improvement of the varices in 24%, no change in 41%, and worsening in 34%. In 59 instances varices spontaneously disappeared, but in many of these cases that were followed further the varices were seen to return. In other cases varices seemed remarkably static over long periods. Varices show so much spontaneous fluctuation that they cannot be considered a proper means for judging success of surgical portal decompression. Prevention of variceal bleeding remains the best test of shunt effectiveness.