Chronology of histological changes after band ligation of esophageal varices in humans.
OBJECTIVE
While the histological effects of endoscopic sclerotherapy in humans have been extensively described, the effects of endoscopic ligation have been reported in only two cases. The purpose of this study was to reconstruct the chronological sequence of histological changes after ligation of esophageal varices.


METHODS
Autopsy specimens from six patients who received ligation of varices from nine hours to 22 months ante-mortem were evaluated for gross and microscopic changes.


RESULTS
Early after ligation, the appearance was that of a polyp with its base compressed by the band. Variceal thrombosis was seen on day 2. Varying degrees of ischemic necrosis of the polyp were present on days 0-5. If the bands did not remain in situ for two days (premature loss), necrosis of the polyp and dilated variceal vessels were seen. On day 22, superficial ulcers were observed. After complete healing, fibrosis was seen in the submucosa.


CONCLUSIONS
The changes seen in the present study are similar to those described in animals. The delay in ulcer healing, compared with the gross changes reported during follow-up endoscopic examinations, may be related to the severity of the underlying illness and the compromised immune status of patients in the present series.
Polski
J M
JM
Dept. of Pathology, Saint Louis University School of Medicine, Missouri, USA.
Brunt
E M
EM
Saeed
Z A
ZA
D000328:Adult; D002910:Chronology as Topic; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000276:immunology / Q000473:pathology* / Q000601:surgery*; D004947:Esophagus / Q000276:immunology / Q000473:pathology / Q000601:surgery; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009387:Neoprene / Q000009:adverse effects / Q000627:therapeutic use; D011127:Polyps / Q000209:etiology / Q000276:immunology / Q000473:pathology; D012408:Rubber / Q000009:adverse effects / Q000627:therapeutic use; D013927:Thrombosis / Q000209:etiology / Q000276:immunology / Q000473:pathology; D014945:Wound Healing / Q000502:physiology
D012408:Rubber; D009387:Neoprene