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Influence of extravariceal collateral channel pattern on recurrence of esophageal varices after sclerotherapy

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Abstract

We investigated the influence of extravariceal collateral channel pattern on the recurrence of esophageal varices after sclerotherapy. One hundred and fifteen patients with cirrhosis and esophageal varices were studied. They were divided into four groups according to extravariceal collateral pattern on portal venography. Group 1 patients had neither paraesophageal veins nor gastrorenal veins (n-49); group 2 patients had paraesophageal veins only (n=30); group 3 patients had gastrorenal veins only (n=25); and group 4 patients had paraesophageal veins plus gastrorenal veins (n=11). Sclerotherapy was repeated to eradicate esophageal varices and follow-up endoscopic examination were performed. The overall recurrence-free rate at 36 months was 68%. The log-rank test showed the recurrence-free rate to be significantly higher in group 3 (76%) and group 4 patients (89%) than in group 1 patients (51%;P<0.05 andP<0.05, respectively). Although the recurrence-free rate was higher in group 4 than in group 2 patients (59%), this did not reach the level of significance (P=0.10). No significant differences were found between other pairs of groups. These results suggest that gastrorenal veins play an important role in the protection against recurrent esophageal varices after sclerotherapy, while the protective role of paraesophageal veins appears to be small.

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References

  1. Terblance J, Burroughs AK, Hobbs KEF. Controversies in the management of bleeding esophageal varices (first of two parts). N Engl J Med 1989;320:1393–1398.

    Google Scholar 

  2. Terblance J, Burroughs AK, Hobbs KEF. Controversies in the management of bleeding esophageal varices (second of two parts). N Engl J Med 1989;320:1496–1475.

    Google Scholar 

  3. Korula J, Balart LA, Radovan G, et al. A prospective, randomized controlled trial of chronic esophageal varices sclerotherapy. Hepatology 1985;5:584–589.

    Article  PubMed  CAS  Google Scholar 

  4. Westaby D, Macdougall BRD, Williams R. Improved survival following injection sclerotherapy for esophageal variceas: Final analysis of a controlled trial. Hepatology 1985;5:827–830.

    Article  PubMed  CAS  Google Scholar 

  5. Low DE, Kozarek RA, Ball TJ, et al. Endoscopic variceal sclerotherapy as primary treatment for bleeding esophageal varices. J Clin Gastroenterol 1989;11:253–259.

    Article  PubMed  CAS  Google Scholar 

  6. Lin CY, Lin PW, Tsai HM, et al. Influence of paraesophageal venous collaterals on efficacy of endoscopic sclerotherapy for esophageal varices. Hepatology 1994;19:602–608.

    Article  PubMed  CAS  Google Scholar 

  7. Kitano S, Koyanagi N, Iso Y, et al. Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate. Hepatology 1987;7:810–815.

    Article  PubMed  CAS  Google Scholar 

  8. Smith-Laing G, Camilo ME, Dick R, et al. Percutaneous transhepatic portography in the assessment of portal hypertension. Gastroenterology 1980;78:197–205.

    PubMed  CAS  Google Scholar 

  9. Japanese Society for Portal Hypertension. The general rules for recording endoscopic findings on esophageal varices. Jpn J Surg 1980;10:84–87.

    Article  Google Scholar 

  10. Pagliaro L, D'Amico G, Sörensen TIA, et al. Prevention of first bleeding in cirrhosis. A meta-analysis of randomized trials of nonsurgical treatment. Ann Intern Med 1992;117:59–70.

    PubMed  CAS  Google Scholar 

  11. The North 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 multicenter study. N Engl J Med 1988;319:983–989.

    Google Scholar 

  12. Okuda K, Suzuki K, Musha H, et al. Percutaneous transhepatic catheterization of the portal vein for the study of portal hemodynamics and shunts. A preliminary report. Gastroenterology 1977; 73:279–284.

    PubMed  CAS  Google Scholar 

  13. Ayres SJ, Goff JS, Warren GH, et al. Esophageal ulceration and bleeding after flexible fiberoptic esophageal vein sclerosis. Gastroenterology 1982;83:131–136.

    PubMed  CAS  Google Scholar 

  14. Bacon BR, Bailey-Newton RS, Connors AF Pleural effusions after endoscopic variceal sclerotherapy. Gastroenterology 1985; 88:1910–1914.

    PubMed  CAS  Google Scholar 

  15. Ayers SJ, Goff JS, Warren GH. Endoscopic sclerotherapy for bleeding esophageal varices: Effects and complications. Ann Intern Med 1983;98:900–903.

    Google Scholar 

  16. Pugh RNH, Murray-Lyron M, Dawson JL, et al. Transsection of oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60:646–649.

    Article  PubMed  CAS  Google Scholar 

  17. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481.

    Article  Google Scholar 

  18. Toyonaga A, Iwao T, Sumino M, et al. Portal pressure after prophylactic sclerotherapy in patients with high-risk varices. J Hepatol 1994;21:515–520.

    Article  PubMed  CAS  Google Scholar 

  19. Tanoue K, Hashizume M, Wada H, et al. Effect of endoscopic injection sclerotherapy on portal hypertensive gastropathy: A prospective study. Gastrointest Endosc 1992;38:582–585.

    Article  PubMed  CAS  Google Scholar 

  20. Hou MC, Lin HC, Chen CH, et al. Changes in portal hypertensive gastropathy after endoscopic variceal sclerotherapy or ligation: An endoscopic observation. Gastrointest Endosc 1995;42:139–144.

    Article  PubMed  CAS  Google Scholar 

  21. Sarin SK, Sreenivas DV, Lahoti D, et al. Factors influencing development of portal hypertensive gastropathy in patients with portal hypertension. Gastroenterology 1992;102:994–999.

    PubMed  CAS  Google Scholar 

  22. Iwao T, Toyonaga A, Shigemori H, et al. Portal-hypertensive gastropathy develops less in cirrhotic patients with fundal varices. J Hepatol 1997;26:1235–1241.

    Article  PubMed  CAS  Google Scholar 

  23. Watanabe K, Kimura K, Matutani S, et al. Portal hemodynamics in patients with gastric varices. Gastroenterology 1988;95:434–440.

    PubMed  CAS  Google Scholar 

  24. Iwao T, Toyonaga A, Sumino M, et al. Portal hypertensive gastropathy in patients with cirrhosis. Gastroenterology 1992;102: 2060–2065.

    PubMed  CAS  Google Scholar 

  25. Luca A, García-Pagán JC, Bosch J, et al. Effects of ethanol consumption on hepatic hemodynamics in patients with alcoholic cirrhosis. Gastroenterology 1997;112:1284–1289.

    Article  PubMed  CAS  Google Scholar 

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Sakai, T., Iwao, T., Oho, K. et al. Influence of extravariceal collateral channel pattern on recurrence of esophageal varices after sclerotherapy. J Gastroenterol 32, 715–719 (1997). https://doi.org/10.1007/BF02936945

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  • DOI: https://doi.org/10.1007/BF02936945

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