Procedures for Managing Cirrhosis

Esophageal varices are similar to varicose veins except that they occur in the lining of the walls of the lower esophagus (swallowing tube). They are a common complication of cirrhosis. If the veins rupture, they can cause serious bleeding that often requires blood transfusion. Once bleeding is controlled, treatment focuses on preventing future bleeding episodes. Ruptured esophageal varices are responsible for a large proportion of the deaths associated with cirrhosis.

Band Ligation

Endoscopy, which consists of a narrow tube mounted with a video camera being inserted into the throat, is used to identify the bleeding site. A rubber band is used to tie off the bleeding portion of the vein.

Endoscopic Sclerotherapy

Endoscopy is again used to identify the bleeding site. It is only useful if the bleeding is in your esophagus. A drug, such as morrhuate sodium (Scleromate) is injected into the bleeding vein, causing it to constrict. This slows the bleeding and allows a clot to form, closing the ruptured vessel. It is necessary to repeat the procedure over 2-3 months to reduce the risk of bleeding again.

Transjugular Intrahepatic Porto-Systemic Shunting (TIPS)

The TIPS procedure is the creation of an artificial connection directly between the portal veins and hepatic veins of your liver. The entire procedure is performed using needles, catheters, wires, and stents placed through a vein in your neck.

In this procedure, a catheter (tube) with a stent (a tube that shunts blood) attached to it is threaded through a vein in your neck into your liver. Using x-ray guidance, the stent is placed within your liver to allow blood to flow more easily through the portal vein. Once in place, the shunt allows blood to return directly to your heart without passing through the varices. TIPS is a good choice for bleeding that is not controlled by endoscopy.

Liver Transplantation

A liver transplant may be necessary when:

  • The complications of cirrhosis cannot be controlled with medical therapy
  • The liver becomes so damaged that it completely stops functioning

In liver transplantation surgery, a diseased liver is replaced with a healthy liver from a donor who has died. In some cases, a portion of the liver of a living, related donor may be used. About 60%-80% of patients survive liver transplantation. Survival rates have improved over the past decade because of drugs, such as cyclosporine, that suppress the immune system and keeps it from attacking and damaging the new liver.

Description of the Procedure —The surgeon makes an incision shaped like a boomerang on the upper part of the abdomen. The old liver is removed, leaving portions of major blood vessels in place. The new liver is inserted and attached to the blood vessels and bile ducts. To help with bile drainage, a tube will also be inserted in the bile duct during surgery. The skin is closed with stitches.

Recovery time varies and may depend, in part, on your overall health before the transplant. Most patients are able to return to normal or near-normal activities 6-12 months after transplantation. To reduce the chance that your body will reject the donor liver, you will need to take immunosuppressive drugs for the rest of your life. Several of these medications can produce side effects, so be sure to discuss special precautions with your doctor.