Effects of Esophageal Varice Eradication on Portal Hypertensive Gastropathy and Fundal Varices: A Retrospective and Comparative Study

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 F(1), 3 F(2)) in the EVL group and 13 patients (10 F(1), 3 F(2)) in the EST group had fundal varices before variceal eradication (P > 0.05). Fundal varices were detected in 46 (35 F(1), 11F(2)) and 19 (11F(1), 8F(2)) 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.

Natural history of bleeding after esophageal variceal eradication in patients with extrahepatic portal venous obstruction; a 20-year follow-up

“…14,20 It is interesting to note that in two-thirds of our patients, fundal varices disappeared after esophageal variceal eradication. Gastric varices, particularly those of GOV1 type, are often an extension of esophageal varices and hence are obliterated by injection of sclerosant into the latter.…”

Effect of Portal Hypertension in the Small Bowel: An Endoscopic Approach

“…Sarin et al found that among 88 patients with PHG, 74% developed this condition after variceal eradication [29]. The severity of the PHG also seems to increase after endoscopic variceal treatment, either by sclerotherapy or by band ligation [31]. On the other hand, it seems that esophageal variceal band ligation does not affect the incidence of anorectal varices or PHC [32].…”

Is endoscopic band ligation necessary for primary prophylaxis of esophageal varices without high bleeding risks?

“…2 Indeed, we recommend caution in performing band ligation in patients with smaller varices, as highlighted by a recent study. 3 This demonstrated a high incidence of banding-related bleeding when patients with smaller varices were included. In our study, none of the patients had red signs at endoscopy, but it is not clear whether patients without red signs should be excluded from band ligation.…”

“…Recently, we have reported that esophageal variceal eradication with either band ligation or sclerotherapy increased both the incidence and the severity of portal hypertensive gastropathy and gastric varice formation. 3 We wonder about the number of patients who developed gastric varices and portal hypertensive gastropathy in each group in the study performed by Tripathi et al This will help us to have some information whether gastric varix formation and development of portal hypertensive gastropathy occur as complications of endoscopic variceal treatment or as a natural course of the underlying portal hypertension and cirrhosis. Reply:…”