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May 30, 1953


Author Affiliations

Brookline, Mass.

From the Third Surgical Service, Boston University, Boston City Hospital. Assistant Professor of Surgery, Boston University School of Medicine, Junior Visiting Surgeon, Boston City Hospital (Dr. Miller) and Assistant in Surgery, Boston University School of Medicine, Teaching Resident (formerly) Third Surgical Service, Boston City Hospital (Dr. Owen).

JAMA. 1953;152(5):377-379. doi:10.1001/jama.1953.03690050001001

The problem of treating bleeding esophageal varices is a difficult one. Ratnoff and Patek1 have shown that the first hemorrhage is fatal in one-third of these cases. Patek2 states that the two-thirds of the patients who survive have only a 50% chance of being alive at the end of a year. It is clear from these findings that, in addition to controlling the initial hemorrhage, some definitive procedure is called for to prevent recurrences. According to Welch,3 85 to 90% of patients with portal hypertension will have liver disease. Since the work of Whipple4 and of Blakemore and Lord,5 porta caval anastamosis has become a valuable procedure in the interim control of hemorrhage from esophageal varices, but its complexity has proved too great for it to be used in poor risk patients or in instances of acute hemorrhage.

Numerous methods of controlling hemorrhage in the

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