title: Sustained rise of portal pressure after sclerotherapy, but not band ligation, in acute variceal bleeding in cirrhosis.
abstract: During variceal bleeding, several factors may increase portal pressure, which in turn may precipitate further bleeding. This study investigates the early effects of endoscopic injection sclerotherapy (EIS) and endoscopic band ligation (EBL) on hepatic venous pressure gradient (HVPG) during acute bleeding and the possible influence in outcome. In 50 cirrhotic patients with bleeding esophageal varices treated with EIS (n = 25) or EBL (n = 25), we performed repeated HVPG measurements before and immediately after endoscopic treatment (time 0) and every 24 hours for a 5-day period. Endotherapy was continued until the varices were too small for further treatment. Both groups were comparable with regard to age, gender, Child-Turcotte-Pugh grade, and HVPG. In the EBL and EIS groups, a significant (P <.0001) increase was observed in mean portal pressure (20.7 mm Hg +/- 4.4 SD and 21.5 mm Hg +/- 4.5 SD, respectively) immediately after treatment (time 0) as compared with pretreatment (18.1 +/- 4.5 and 18.1 +/- 4.0). However, HVPG in the EBL group returned to baseline values within 48 hours after treatment, while in the EIS group it remained high during the 120-hour study period (P <.0001). Bleeding stopped in all patients after endotherapy. During the 42-day follow-up period, the rebleeding rate over time was lower in the EBL group compared with the EIS group (P =.024). Patients with an initial HVPG greater than 16 mm Hg had, despite endoscopic treatment, a significantly higher likelihood of death (P =.024) and overall failure (P =.037) [correction]. In conclusion, during acute variceal bleeding EIS, but not EBL, causes a sustained increase in HVPG, which is followed by a higher rebleeding rate.
authors.affiliation: 2nd Department of Gastroenterology, Athens University, Evangelismos Hospital, Athens, Greece. alavger@hol.gr
authors.forename: Alec
authors.initials: A
authors.lastname: Avgerinos
authors.forename: Anastasios
authors.initials: A
authors.lastname: Armonis
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Stefanidis
authors.forename: Nikoleta
authors.initials: N
authors.lastname: Mathou
authors.forename: Jiannis
authors.initials: J
authors.lastname: Vlachogiannakos
authors.forename: Anastasios
authors.initials: A
authors.lastname: Kougioumtzian
authors.forename: Christos
authors.initials: C
authors.lastname: Triantos
authors.forename: Costas
authors.initials: C
authors.lastname: Papaxoinis
authors.forename: Spilios
authors.initials: S
authors.lastname: Manolakopoulos
authors.forename: Anna
authors.initials: A
authors.lastname: Panani
authors.forename: Sotiris A
authors.initials: SA
authors.lastname: Raptis
mesh_terms: D000208:Acute Disease; D004638:Emergency Treatment; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011446:Prospective Studies; D012008:Recurrence; D015911:Sclerotherapy / Q000009:adverse effects*