The Effects of Chronic Endoscopic Variceal Sclerotherapy on Systemic and Splanchnic Hemodynamics in Patients with Cirrhosis.

Abstract

The aim of this study was to determine whether endoscopic variceal sclerotherapy affects systemic or splanchnic hemodynamics.Wemeasured hemodynamic parameters before and after the first course of sclerotherapy in 35 patients with cirrhosis. Following sclerotherapy, there was a significant decrease in cardiac index and a significant increase in systemic vascular resistance. Changes in hepatic venous pressure gradient varied from patient to patient with no statistically significant change in the group overall. However, all 20 patients with a decline in the hepatic venous pressure gradient had a concomitant decrease in cardiac index and/or a large extravariceal shunt. The multivariate analysis disclosed that the decrease in cardiac index was a statistically significant contributor for the decline in hepatic venous pressure gradient. Weconclude that the obliteration ofesophageal varices by sclerotherapy significantly reverses the hyperdynamic circulatory state in patients with cirrhosis. Spontaneous changes in systemic hemodynamicsand the interaction with hepatic hemodynamics must be taken into account when evaluating hepatic hemodynamics in patients undergoing variceal sclerotherapy.

Endoscopic injection sclerotherapy with n-butyl-2-cyanoacrylate for ruptured duodenal varices

“…We have previously reported that patients with esophageal varices whose hepatic venous pressure gradient decreased after EIS showed a decrease in cardiac index or a large extravariceal shunt after EIS. 33 Our present patient's portal pressure decreased after EIS. This was attributed to the presence of a splenorenal shunt.…”

“…33 At present, little is known about the effects of EIS on hemodynamics and subsequent hepatic function in patients with duodenal varices. In our patient, the portal pressure was 22 mmHg before EIS, and this was reduced to 16 mmHg after EIS.…”

Azygos venous blood flow while fasting, postprandially, and after endoscopic variceal ligation, measured by magnetic resonance imaging

“…Previous studies have shown a decrease of azygos blood flow by approximately 54% in patients who have prophylactic endoscopic injection variceal sclerotherapy. 23 Although the reason for the intra-study difference in azygos blood flow decrease is not clear, it is probably due to differences in the methods used to accomplish esophageal variceal obliteration. However, these results suggest that the majority of azygos blood flow is collateral blood flow through esophageal varices and that this is significantly reduced by successful EVL.…”