The Use of Fructose to Determine the Patency of Portal-Systemic Shunts

Abstract

The construction of portal-systemic venous shunts is widely practiced for the relief of portal hypertension with associated bleeding esophageal varices. Information regarding the postoperative patency of such a shunt is frequently of considerable value to the surgeon. The means now available for evaluating the status of such a venous anastomosis include the use of serial barium esophagograms, splenoportography (if the spleen has not been removed), and the ammonium citrate tolerance test.¹ The barium esophagogram does not yield definitive information, and the latter 2 tests carry a small but definite risk to the patient. The purpose of this report is to present our experience with a test which is simple to perform and involves little or no risk or discomfort for the patient. After oral ingestion of fructose (levulose) by the normal individual, a certain fraction is converted to glucose during passage through the intestinal mucosa,⁵ and the remainder