The influence of endoscopic variceal ligation on the portal pressure gradient in cirrhotics.
OBJECTIVE
After variceal eradication by endoscopic ligation, fundal varices and worsening of portal hypertensive gastropathy can occur. The aim of this study is to verify the impact of the eradication of esophageal varices by endoscopic ligation on the portal pressure gradient, worsening of portal hypertensive gastropathy and development of fundal varices.


METHODS
Twenty-two (15M/7F, mean age: 54.5 years) cirrhotics with previous variceal bleeding were submitted to measurement of hepatic venous pressure gradient before and after variceal eradication by endoscopic ligation.


RESULTS
The mean hepatic venous pressure gradient in the first measurement was 14.1 mmHg and after eradication, 13.5 mmHg (p = 0.403). After eradication, 12 patients experienced a reduction in portal pressure and 10, an elevation. Three patients developed fundal varices. Their mean gradient before treatment was 22 mmHg and 18.8 mmHg after therapy (p = 0.368). The gastropathy worsened in 9 patients (mean gradient before therapy of 15.2 mmHg; and 16.1 mmHg after treatment) (p = 0.303). The initial pressure gradient of these patients was not different from the other 13 cases (p = 0.463).


CONCLUSIONS
The esophageal variceal eradication by endoscopic band ligation does not alter the hepatic venous pressure gradient. There is no significant variation in the portal pressure of patients in whom there was a worsening of portal hypertensive gastropathy or fundal varices development.
Pereira-Lima
Júlio C
JC
Department of Gastroenterology and Hepatology, Porto Alegre School of Medical Sciences (FFFCMPA), Santa Casa University Hospital, Porto Alegre, Brazil. jpereiralima@zaz.com.br
Zanette
Marília
M
Lopes
César Vivian
CV
de Mattos
Angelo A
AA
D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005748:Gastric Fundus / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology* / Q000503:physiopathology; D008026:Ligation / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology; D011183:Postoperative Complications; D012720:Severity of Illness Index