The effects of chronic endoscopic variceal sclerotherapy on systemic and splanchnic hemodynamics in patients with cirrhosis.
The aim of this study was to determine whether endoscopic variceal sclerotherapy affects systemic or splanchnic hemodynamics. We measured 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. We conclude that the obliteration of esophageal varices by sclerotherapy significantly reverses the hyperdynamic circulatory state in patients with cirrhosis. Spontaneous changes in systemic hemodynamics and the interaction with hepatic hemodynamics must be taken into account when evaluating hepatic hemodynamics in patients undergoing variceal sclerotherapy.
Ota
K
K
First Department of Internal Medicine, School of Medicine, Fukuoka University.
Shijo
H
H
Kokawa
H
H
Kubara
K
K
Kim
T
T
Akiyoshi
N
N
Yokoyama
M
M
Okumura
M
M
D004724:Endoscopy; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006503:Hepatic Veins / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008102:Liver Circulation / Q000187:drug effects / Q000502:physiology*; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009829:Oleic Acids / Q000627:therapeutic use; D010953:Plasma Volume; D012189:Retrospective Studies; D015911:Sclerotherapy; D013152:Splanchnic Circulation / Q000187:drug effects / Q000502:physiology*; D014690:Venous Pressure / Q000187:drug effects / Q000502:physiology
D009829:Oleic Acids; C033343:ethanolamine oleate