Eradication of esophageal varices by sclerotherapy combined with argon plasma coagulation: Effect of portal hemodynamics and longitudinal clinical course.
OBJECTIVE
To demonstrate the effect of endoscopic injection sclerotherapy (EIS) with argon plasma coagulation (APC) as a primary/secondary prophylaxis for esophageal varies (EV) on portal hemodynamics and long-term outcomes in cirrhosis.


METHODS
This prospective study included 48 cirrhotic patients (64.5 ± 11.4 years; 26 bleeders, 22 non-bleeders). Post-treatment outcomes (EIS and APC; median observation period, 12.8 months for recurrence and 21.1 months for prognosis) were evaluated with respect to the findings of hepatic venous catheterization, Doppler ultrasound, and endoscopic ultrasonography (EUS).


RESULTS
All patients showed EV eradication after endoscopic treatment, and a decreased frequency of a patent left gastric vein (pre: 83.3%, post: 27.1%, P < 0.001). However, hepatic venous pressure gradient (HVPG, mmHg) remained unchanged after the treatment, pre: 16.1 ± 3.6, post: 15.6 ± 3.8 (P = 0.269). Cumulative variceal recurrence/rebleeding rates were 25.5%/5.6% and 62.4%/23.1% at 1 and 3 years, respectively. Post-treatment EUS finding, area of submucosal vessels in the cardia ≥12 mm2 was the only significant factor for variceal recurrence (hazard ratio 9.769, 95% confidence interval 3.046-31.337; P < 0.001). Cumulative recurrence rate was significantly higher in patients with area of submucosal vessels in the cardia ≥12 mm2 (58.3% at 1 year and 100% at 3 years) than in those without (11.4% at 1 year and 40.9% at 3 years, P < 0.001). Cumulative overall survival rates were 95.2% and 71.9% at 1 and 3 years, respectively, showing no significant relationship with HVPG.


CONCLUSIONS
EIS with APC for EV is unlikely to have a significant influence on portal pressure.
Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan.
Takayuki
T
Kondo
Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan.
Hitoshi
H
Maruyama
Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan.
Soichiro
S
Kiyono
Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan.
Tadashi
T
Sekimoto
Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan.
Taro
T
Shimada
Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan.
Masanori
M
Takahashi
Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan.
Hidehiro
H
Okugawa
Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chiba, Japan.
Osamu
O
Yokosuka
Center for Frontier Medical Engineering, Chiba University, Chiba, Japan.
Hiroshi
H
Kawahira
Center for Frontier Medical Engineering, Chiba University, Chiba, Japan.
Tadashi
T
Yamaguchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057908:Argon Plasma Coagulation / Q000379:methods*; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology*; D011446:Prospective Studies; D012008:Recurrence; D015911:Sclerotherapy / Q000379:methods*; D055502:Secondary Prevention; D013997:Time Factors
cirrhosis; endoscopy; esophageal varices; hepatic venous pressure gradient; sclerotherapy