Short-Term Portal Hemodynamic Effects of Endoscopic Embolization for Esophageal Varices

Abstract

Background/Aim: Endoscopic embolization (EE) is a specialized treatment that obliterates esophageal varices along with their associated blood supply. The purpose of this study was to investigate the short-term effects of EE for esophageal varices on portal hemodynamics and liver function. Methods: Thirty patients with esophageal varices were included in this study. The portal blood flow was measured by an ultrasonic duplex Doppler system before and after EE. EE was performed by freehand intravariceal injection of 5% ethanolamine oleate with iopamidol with the aid of a balloon attached to the tip of an endoscope under fluoroscopy. Results: For the blood supply system, endoscopic varicography at the time of EE was able to show the vessels of the cardiac branch of the left gastric vein in 93% of the cases, the cardiac venous plexus in 90%, the trunk of the left gastric vein in 27%, the lesser curvature branch of the left gastric vein in 10%, the fundic branch of the short gastric vein in 13%, and the posterior gastric vein in 13%. For the blood drainage system, endoscopic varicography was able to show the paraesophageal vein in 39% of the cases, the inferior phrenic vein in 17%, and the mediastinal vein in 13%. No clotting was detected after EE in the intra- and extraportal veins in any of the cases. The flow velocities in the main portal vein before and after EE were 14.2 ± 3.2 and 15.5 ± 3.5 cm/s, respectively, showing no significant change. The cross-sectional area of the portal vein before and after EE was 0.96 ± 0.21 and 1.04 ± 0.23 cm², and the flow volume of the portal vein was 817 ± 288 and 930 ± 189 ml/min, both also showing no significant change. The blood laboratory parameters showed no significant change after EE. Conclusions: We conclude that neither portal blood flow nor liver function were damaged by EE, although both the varices and their associated blood supply were obliterated.

Isolated Gastric Varices: Prevalence, Clinical Relevance and Natural History

“…A similar association between the two has been reported by other workers [8, 19]. However, Chikamori et al [23]on the other hand did not find endoscopic embolization for oesophageal varices to produce any significant effect on the portal blood flow. They however did not study the gastric mucosal blood flow in particular.…”

Partial splenic artery embolization in cirrhotic patients

“…PSE decreases splenic blood flow, splenic venous pressure, and portal venous pressure [26][27][28] . Additionally, in a trial of 7 patients with cirrhosis and hepatocellular carcinoma treated with a combination of transcatheter hepatic arterial embolization and PSE, Han et al [29] demonstrated a significant decrease in portal venous pressures following therapy.…”

“…Additionally, in a trial of 7 patients with cirrhosis and hepatocellular carcinoma treated with a combination of transcatheter hepatic arterial embolization and PSE, Han et al [29] demonstrated a significant decrease in portal venous pressures following therapy. Interestingly, however, most studies which explored the hemodynamic effects of PSE did not demonstrate improvements in portal blood volume [26][27][28] . Portal venous hypertension is associated with numerous clinical manifestations.…”

Percutaneous transretroperitoneal direct approach to occlude a major shunt in a patient with extrahepatic portal–systemic encephalopathy

“…In our patient the injection of both coils and ethanolamine oleate effectively maintained complete obstruction of a portal–systemic venous shunt, and furthermore liver function has been improved for 4 years. The mechanism of eradication of splenorenal shunt by percutaneous transretroperitoneal obliteration is the same as that of endoscopic injection sclerotherapy 14 or transjugular retrograde obliteration for the esophagogastric varices 15 . 5% EOI has the ability to damage the endothelial cells and produce thrombi when it is injected in a controlled way.…”