Effects of endoscopic variceal ligation on portal hypertensive gastropathy and gastric mucosal blood flow.
OBJECTIVE
Portal hypertensive gastropathy (PHG) has been recognized recently as a potential cause of upper gastrointestinal tract bleeding and is associated with a change in gastric hemodynamic indices in cirrhotic patients with portal hypertension. Endoscopic variceal ligation (EVL) is the treatment of choice for esophageal varices. We investigated the early effect of EVL on PHG and gastric mucosal blood flow (GMBF).


METHODS
We examined 35 cirrhotic patients who were treated by EVL. PHG was evaluated endoscopically and GMBF was measured by laser Doppler flowmetry before and 1 or 2 wk after EVL.


RESULTS
After EVL, only two patients (5.7%) developed severe PHG, 6 (17.1%) developed mild PHG, and 27 (77.1%) showed no change in endoscopic appearance of PHG. In those patients who developed PHG, EVL significantly decreased GMBF at the corpus (p < .05). However, no significant changes of GMBF at the corpus were noted after EVL in those patients who had no worsening of endoscopic features. EVL had no effect on GMBF at the antrum in any patients.


CONCLUSIONS
Endoscopic variceal ligation is safe and does not lead, at least within 1-2 wk, to worsening of gastropathy in most cases. Our finding that gastropathy developed in the presence of reduced GMBF may suggest that PHG develops as a result of congestion caused by blockade of gastric blood drainage rather than by hyperemia.
Yoshikawa
I
I
Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan, School of Medicine, Kitakyushu.
Murata
I
I
Nakano
S
S
Otsuki
M
M
D000328:Adult; D003627:Data Interpretation, Statistical; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005753:Gastric Mucosa / Q000098:blood supply*; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D017078:Laser-Doppler Flowmetry; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications; D013272:Stomach Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology