title: Effect of endoscopic variceal obliteration by band ligation on portal hypertensive gastro-duodenopathy: endoscopic and pathological study.
abstract: OBJECTIVE
  A few studies have shown that the degree of portal hypertensive gastropathy (PHG) and duodenopathy (PHD) has been worsening after the introduction of therapeutic endoscopic interventions. This study aimed to determine the impact of esophageal variceal eradication by endoscopic variceal ligation (EVL) on PHG and PHD using endoscopic and histopathologic assessment.
  
  
  METHODS
  Fifty patients with esophageal varices for which EVL was indicated were included. EVL was carried out until complete variceal eradication was achieved. The degree of severity of PHG and PHD were recorded before and 4 weeks after variceal eradication. Biopsies were taken from various parts of the stomach and duodenum before and 4 weeks after variceal eradication.
  
  
  RESULTS
  The whole Baveno score (4 vs. 2.5) increased significantly after variceal eradication when compared to those before eradication (p < 0.05). After obliteration, only 19 (38 %) patients had mild PHG versus 37 (74 %) before EVL, while severe PHG was found in 31 (62 %) patients versus 11 (22 %) before EVL and the difference was highly statistically significant. No significant changes were found regarding endoscopic PHD lesions before and after variceal eradication. Pathological changes as average blood vessel count, angiogenesis, ectasia and blood extravasation in stomach and duodenum significantly increased after EVL. Large esophageal varices (III-IV) and Baveno score (>1) at baseline endoscopy were independent risk factors for development of severe PHG after variceal obliteration (p < 0.05).
  
  
  CONCLUSIONS
  PHG increased significantly, endoscopically and pathologically, after variceal obliteration by EVL. Although PHD did not significantly change as documented by endoscopy, pathological examination documented statistically significant changes in the duodenum after EVL.
authors.affiliation: Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Reda
authors.initials: R
authors.lastname: Elwakil
authors.affiliation: Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. drashrafbreedy@yahoo.com.
authors.forename: Ashraf Mohammad
authors.initials: AM
authors.lastname: Al Breedy
authors.affiliation: Department of Pathology, Ain Shams University, Cairo, Egypt.
authors.forename: Hoda Hassan Abou
authors.initials: HH
authors.lastname: Gabal
mesh_terms: D001706:Biopsy; D004386:Duodenum / Q000473:pathology; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013270:Stomach / Q000473:pathology
keywords: Endoscopic variceal ligation; Portal hypertension; Portal hypertensive duodenopathy; Portal hypertensive gastropathy