Histologic and manometric studies on the esophagus following endoscopic sclerotherapy.
OBJECTIVE
The aim of this work was to study the histologic and manometric changes in the distal esophagus beyond 2 years following endoscopic sclerotherapy (EST) and/or surgical intervention, and to try to understand the etiological factors associated with these changes.


METHODS
Forty patients, with an average age of 61.5 years, were studied for 2-12 years following sclerotherapy and/or surgical intervention. The causes of liver disease were alcoholic cirrhosis (78.6%), primary biliary cirrhosis (14.3%), and chronic aggressive hepatitis (7.1%). A predominant number of cases (65%) had a mesocaval interposition shunt due to the failure of EST, 32.5% EST alone, and 2.5% esophageal devascularization. All patients had esophageal manometry following mucosal biopsies taken in duplicate endoscopically from three levels of the distal esophagus.


RESULTS
In the EST and shunt groups, 88.5% had manometric abnormalities, esophagitis, and chronic inflammatory changes. In the EST group, all but two patients had manometric abnormalities and chronic inflammatory changes. Analysis of the patient groups on the basis of the number of EST sessions and the amount of sclerosant injected showed that both histologic changes and dysmotility were more profound in those treated over five times with EST. The differences were significant.


CONCLUSIONS
It appears that EST causes persistent manometric abnormalities and chronic inflammatory changes in the distal esophagus, the severity of which seems to vary directly with the frequency of sclerotherapy and not amount of sclerosant injected.
Sharma
Peeyush
P
Department of Surgery, Lund University Hospital, Lund, Sweden. doctorsharma@aol.co.uk
Hagerstrand
Inga
I
Sharma
Dave Krishan
DK
D001706:Biopsy; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D004941:Esophagitis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D004947:Esophagus / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015911:Sclerotherapy / Q000009:adverse effects*; D012720:Severity of Illness Index