How does endoscopic sclerotherapy alter splanchnic hemodynamics?

Abstract

Endoscopic sclerotherapy is widely employed for esophageal variceal hemorrhage. However it has side effects and can aggravate portal hypertension by suppression of portosystemic shunt. The purpose of the present investigation was to study the effect of variceal thrombosis on hepatic venous pressure gradient and azygos blood flow. Eight alcoholic cirrhotic patients with a first variceal hemorrhage were included. According to Child Pugh's classification, 4 patients were group A, 2 group B and 2 group C. At each session 40 to 60 ml of 1 p. 100 polidocanol were injected into the varices. A hemodynamic study was performed in each patient before and about 1 week after variceal obliteration (mean 3.3 procedures). Mean value of hepatic venous pressure gradient was 16.6 ± 5.5 mm Hg and 17.0 ± 3.8, respectively, before sclerotherapy and after eradication of varices; azygos blood flow 663 ± 506 ml/min before and 682 ± 522 after; cardiac output was 6.5 ± 0.7 ml/min before and 6.5 ± 0.8 after. None of these differences were significant. These results suggest that endoscopic sclerotherapy using polidocanol does not change hepatic venous pressure gradient and azygos blood flow, and does not lower blood flow through the gastroesophageal collaterals draining into the azygos vein. This is consistent with the hypothesis that thrombosis remains localized.