Clinical management of gastric cancer and concomitant esophagogastric varices

We report the late results of treatment of 13 consecutive patients with gastric cancer and concomitant esophagogastric varices. Of seven good‐risk patients classified as Child's class A or B, gastrectomy together with selective shunt operation was performed in two, total gastrectomy with splenectomy in three, and distal partial gastrectomy with paraesophageal devascularization without splenectomy in one. The remaining patient with early gastric cancer underwent distal partial gastrectomy following repeated endoscopic injection sclerotherapy (EIS) for treatment of the esophageal varices. Although the majority of patients who underwent surgical repair of varices (i.e., shunt, splenectomy, or devascularization) died, total gastrectomy with splenectomy was the only procedure that led to control of the esophageal varices. Since partial gastrectomy combined with EIS limits the morbidity and mortality of an extensive resection and at the same time controls esophageal variceal bleeding, it is probably the procedure of choice for patients with a carcinoma in the lower two‐thirds of the stomach. Concerning non‐surgical cases, two patients were effectively treated using laser endoscopy and EIS, without the occurrence of variceal bleeding. The remaining four patients, given chemotherapy or irradiation for treatment of gastric carcinoma, died within 4 months with variceal bleeding or liver failure. For the poor‐risk patients with evidence of severe liver dysfunction, laser treatment and EIS would be the treatment of choice.