Abstract
Esophageal varice eradication results in gastric hemodynamic changes. The aim of this study was to detect the influence of variceal eradication on portal hypertensive gastropathy (PHG) and fundal varices and to compare the results of two therapeutic methods (endoscopic variceal ligation and endoscopic sclerotherapy). A total of 114 consecutive patients with cirrhosis and portal hypertension who underwent elective endoscopic variceal ligation (EVL) (85 patients) or endoscopic sclerotherapy (EST) (29 patients) for obliteration of esophageal varices were selected for this study. Both groups were compared for PHG and fundal varice formation before and after eradication. Fifty-eight (68.2%) patients in the EVL and 18 (62.1%) patients in the EST group had PHG before esophageal varice eradication (P > 0.05). PHG grade after eradication of esophageal varices by both EVL and EST was significantly higher compared to pre-eradication. PHG grade and aggregation were similar in both groups. Thirty-seven patients (34 F1, 3 F2) in the EVL group and 13 patients (10 F1, 3 F2) in the EST group had fundal varices before variceal eradication (P > 0.05). Fundal varices were detected in 46 (35 F1, 11F2) and 19 (11F1, 8F2) patients in the EVL and EST groups after eradication, respectively. There was a statistically significant increment in occurrence of fundal varices after eradication with EVL and EST groups. There was no significant difference regarding fundal varice development after esophageal variceal eradication in both groups. After varical eradication, PHG was found in 57 (87.7%) and 39 (79.6%) patients with and without fundal varices, respectively (P > 0.05). Esophageal eradication with EVL and EST increases both the incidence and the severity of PHG and fundal varice formation. Both methods have comparable influences on PHG and fundal varices.
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Sarin SK, Govil A, Jain AK, et al.: Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices: influence on gastropathy, gastric varices and variceal recurrence. J Hepatol 26:826–832, 1997
Lo GH, Lai KH, Cheng JS, et al.: Prevalence of paraesophageal varices and gastric varices in patients achieving variceal obliteration by banding ligation and by injection sclerotherapy. Gastrointest Endosc 49:428–436, 1999
D'Amico G, Montalbano L, Traina M, et al.: Natural history of congestive gastropathy in cirrhosis. Gastroenterology 99:1558–1564, 1990
Sarin SK, Sreevinas Dv, Lahoti D, et al.: Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension. Gastroenterology 102:994–999, 1992
Pena J, Rivero M, Sanchez E, et al.: Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage: prospective randomized trial.: Gastrointest Endosc 49:417–423, 1999
Hou MC, Lin HC, Chen CH, et al.: Changes portal hypertensive gastropathy after endoscopic variceal sclerotherapy and ligation: an endoscopic observation. Gastrointest Endosc 42:139–144, 1995
Iwao T, Toyanaga A, Ikegami M, et al.: McCormack's endoscopic signs for diagnosing with gastroesophageal varices. Gastrointest Endosc 40:470–473, 1994
Japanese Research Society for Portal Hypertension: The general rules for recording endoscopic findings on esophageal varices. Jpn J Surg 10:84–87, 1980
Tayama C, Iwao T, Oho K, et al.: Effect of large fundal varices on changes in gastric mucosal hemodynamics after endoscopic variceal ligation. Endoscopy 30:25–31, 1998
Iwao T, Toyonaga A, Oho K, et al.: Portal-hypertensive gastropathy develops less in patients with cirrhosis and fundal varices. J Hepatol 26:1235–1241, 1997
Pereira-Lima JC, Zanette M, Lopes CV, et al.: The influence of endoscopic variceal ligation on the portal pressure gradient in cirrhotics. Hepatogastroenterology 50:102–106, 2003
Yoshikawa I, Murata I, Nakano S, et al.: Effects of endoscopic variceal ligation on portal hypertensive gastropathy and gastric mucosal blood flow. Am J Gastroenterol 93:71–74, 1998
Lo GH, Lai KH, Cheng JS, et al.: A prospective, randomized trial of sclerotherapy versus ligatonin the management of bleeding esophageal varices. Hepatology 199522:466–71,
Misra SP, Misra V, Dwivedi M: Effect of esophageal variceal band ligation on hemorrhoids, anorectal varices and portal hypertensive colopathy. Endoscopy 34:195–198, 2002
Tanoue K, Hashizume M, Wada H, et al.: Effects of endoscopic injection sclerotherapy on portal hypertensive gastropathy: a prospective study. Gastrointest Endosc 38:582–585, 1992
Lo GH, Liang HL, Lai KH, et al.: The impact of endoscopic variceal ligation on the pressure of the portal venous system. J Hepatol 24:74–80, 1996
Watanebe K, Kimura K, Matsutani S, et al.: Portal hemodynamics in patients with gastric varices. A study in 230 patients with esophageal and/or gastric varices using portal vein catheterization. Gastroenterology 95:434–440, 1988
Guarner C, Soriano G, Tomas A, et al.:: Increased serum nitrite and nitrate levels in patients with cirrhosis: relationship to endotoxemia. Hepatology18:1139–1143, 1993
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Yüksel, O., Köklü, S., Arhan, M. et al. Effects of Esophageal Varice Eradication on Portal Hypertensive Gastropathy and Fundal Varices: A Retrospective and Comparative Study. Dig Dis Sci 51, 27–30 (2006). https://doi.org/10.1007/s10620-006-3078-2
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DOI: https://doi.org/10.1007/s10620-006-3078-2