Bleeding from esophageal or gastric varix is the most critical and life-threatening complication of portal hypertension and the most common cause of deaths in the patients with cirrhosis. In the management of variceal bleeding, the various
therapeutic
interventions including operation and nonoperative procedure were tried, but neither of management was successfully achieved.
Between February 1992 and November 1994, we performed endoscopic injection sclerotherapy(EIS) in 35 cirrhotic patients who had recently bled from esophageal varices and had past history of esophageal variceal bleeding in Chonbuk National
Univesity
Hospital. Among 35 patients, 32 were male and 3 were female. The underlying severity of liver disease was graded A, B or C according to modification of Child-Pugh classification. EIS was repeated every 1 week until the esophageal varices had been
complete obliterated and removed.
To investigate the effects of esophageal varix eradication by EIS on combined pericardial varix, endoscopic examinations were performed both before procedure and after complete EIS sessions and this study was performed to examine a changes of
combined
pericardial varices after EIS procedure for the treatment of esophageal varices bleeding secondary to portal hypertesion. We reviewed medical records and compared changes or sizes of pericardial varices before and after EIS procedure.
Mean follow up peiod was 61 days. Total number of 162 EIS for variceal eradication were performed. Mean session for eradication of esophageal varices was 4.6 per person, mean amount of injected sclerosant was 8.3(1~18cc), mean duration of EIS was
39
days, and mean follow up was 62 days after complete EIS procedure.
In total 162 EIS procedure, complications associated with EIS including substernal discomfort 53.7%(n=87), substernal chest pain 45.7%(n=74), fever 4.9%(n=8), dysphagia 14.2%(n=23) and pleural effusion 3.1%(n=5), were transient and not required
specific
management.
During the follow-up period, complete disapperance of pericardial varix or reduction of size was appeared in 18 cases(51.4%) among total 35 patients. No significant changes of variceal size before and after procedure were 16 cases(45.7%) and only
1
case(2.9%) was more aggravated.
So, these results suggest EIS procedure of esophageal varix on pericardial varix seems either to improve or to maintain the severity of the pericardial gastric varix without aggravation.
|