EFFECT OF BAND LIGATION ON PORTAL HYPERTENSIVE GASTROPATHY AND DEVELOPMENT OF FUNDAL VARICES

Shahid Sarwar, Anwaar A Khan, Altaf Alam, Arshad Kamal Butt, Farzana Shafqat, Kashif Malik, Irfan Ahmad, Aamir Khan Niazi

Abstract


Background: Use of endoscopic therapies for esophageal varices has resulted in increased
prevalence of fundal varices and severe portal hypertensive gastropathy. This study was meant to
compare the effect of band ligation and sclerotherapy on development of fundal varices and portal
hypertensive gastropathy. Methods: Patients with esophageal varices presenting in the endoscopy
unit of Shiakh Zayed Hospital, with at least one previous endoscopy were included. Patient‘s past
record was reviewed for findings and type of treatment given for varices during first endoscopy,
number of endoscopies till date, number of esophageal varices band ligation (EVBL) or
sclerotherapy sessions. All patients underwent upper GI endoscopy and findings were recorded.
Type of treatment patient rendered during first endoscopy either EVBL or sclerotherapy was
correlated to the presence of fundal varices and severity of portal hypertensive gastropathy
observed on present endoscopy, using Chi square test (χ2). Results: Eighty one patients were
included. Mean age of patients was 48.70+ 12.63. Esophageal varices band ligation was carried
out during first endoscopy in 49 (60.5%) patients and sclerotherapy in 31 (38.2%) patients. On
fresh endoscopy, fundal varices were seen in 25 (30.8%) patients. Severe portal hypertensive
gastropathy was found in 26 (32.1%) and mild in 54 (66.7%) patients. Severity of portal
hypertensive gastropathy and presence of fundal varices in recent endoscopy was significantly
more in patients with EVBL in first endoscopy. Conclusion: Band ligation of esophageal varices
is associated with more frequent development of fundal varices and worsening of portal
hypertensive gastropathy compared to sclerotherapy.
Key Words: Baveno scoring, Esophageal varices band ligation, Portal hypertensive gastropathy,

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References


Nevens F, Broeckaert L, Rutgeerts P. The long-term

morbidity and mortality rate in a cohort of patients with liver

cirrhosis and esophageal varices. Hepatogastroenterology

;42:979-984

Gupta TK, Chen L, Groszmann RJ. Pathophysiology of

portal hypertension. Clin Liver Dis. 1997; 1:1-12.

Gupta R, Saraswat VA, Kumar M. Frequency and factors

influencing portal hypertensive gastropathy and

duodenopathy in cirrhotic portal hypertension. J

Gastroenterol Hepatol 1996; 11:728-733.

Rigo GP, Merighi A, Chalen NJ, Mastronardi M, Codeluppi

PL, Ferrari A et al. A prospective study of the ability of three

endoscopic classifications to predict hemorrhage from

esophageal varices. Gastrointest Endosc. 1992; 38:425-429.

Burak KW, Lee SS, Beck PL. Portal hypertensive

gastropathy and gastric antral vascular ectasia (GAVE)

syndrome. Gut 2001; 49:866-72.

Sarin SK, Govil A, Jain AK, Guptan RC, Issar SK, Jain M et

al. Prospective randomized trial of endoscopic sclerotherapy

versus variceal band ligation for esophageal varices:

influence on gastropathy, gastric varices and variceal

recurrence. J Hepatol. 1997 Apr; 26(4):826-32.

De la Pena J, Rivero M, Sanchez E. Variceal ligation compared with endoscopic sclerotherapy for variceal hemorrhage:

prospective randomized trial. Gastrointest Endosc

;49:417-23

The Northern Italian Endoscopic Club for the Study and

Treatment of Esophageal Varices. Prediction of the first

variceal hemorrhage in patients with cirrhosis of the liver and

esophageal varices: a prospective multi-center study. N Engl

J Med. 1988;319:983-989

Sarin SK, Sreenivas DV, Lahoti D. Factors influencing

development of portal hypertensive gastropathy in patients

with portal hypertension. Gastroenterology 1992;102:994-99

Sarin SK, Govil A, Jain AK. Prospective randomized trial of

endoscopic sclerotherapy versus variceal band ligation for

esophageal varices: influence on gastropathy, gastric varices

and variceal recurrence. J Hepatol 1997; 26:826-832.

De BK, Ghoshal UC, Das AS, Nandi S, Mazumder DN.

Portal hypertensive gastropathy and gastric varices before

esophageal variceal sclerotherapy and after obliteration

Indian J Gastroenterol. 1998 Jan;17(1):10-2

Misra SP, Misra V, Dwivedi M. Effect of esophageal

variceal band ligation on hemorrhoids, anorectal varices, and

portal hypertensive colopathy. Endoscopy 2002; 34(3):195-8.

Lo GH, Lai KH, Cheng JS, Hsu PI, Chen TA, Wang EM et

al. The effects of endoscopic variceal ligation and propranolol on portal hypertensive gastropathy: a prospective,

controlled trial. Gastrointest Endosc 2001; 53(6):579-84.

Sato M. Effects of endoscopic variceal ligation on systemic

and splanchnic hemodynamics in patients with cirrhosis.

Kurume Med J 1997; 44(3):191-9.

Kanke K, Ishida M, Yajima N, Saito M, Suzuki Y, Masuyama H et al. Gastric mucosal congestion following endoscopeic variceal ligation analysis using reflectance spectrophotometry Nippon Shokakibyo Gakkai Zasshi 1996;93(10):701-6.

Tayama C, Iwao T, Oho K, Toyonaga A, Tanikawa K. Effect

of large fundal varices on changes in gastric mucosal

hemodynamics after endoscopic variceal ligation. Endoscopy

;30(1):25-31

Korula J, Ralls P. The effects of chronic endoscopic variceal

sclerotherapy on portal pressure in cirrhotics.

Gastroenterology 1991;101(3):800-5.

Pereira-Lima JC, Zanette M, Lopes CV, de Mattos AA. The

influence of endoscopic variceal ligation on the portal

pressure gradient in cirrhotics. Hepatogastroenterology.

;50(49):102-6.


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