During variceal bleeding several factors may increase portal pressure. An increase in portal pressure may precipitate further bleeding.
In this study, physicians from Greece assessed the effects of endoscopic injection sclerotherapy and endoscopic band ligation on the hepatic venous pressure gradient during acute bleeding.
The team evaluated 50 cirrhotic patients with bleeding esophageal varices. Patients were treated with either endoscopic injection sclerotherapy or endoscopic band ligation.
The team performed repeated hepatic venous pressure gradient measurements before and immediately after endoscopic treatment, then every 24 hours for a 5-day period.
Endotherapy was continued until the varices were too small for further treatment.
Both groups were comparable with regard to age, gender, Child-Turcotte-Pugh grade, and hepatic venous pressure gradient.
|Bleeding stopped in all patients after endotherapy.|
The physicians found a significant increase in mean portal pressure immediately after treatment in both groups.
However, the hepatic venous pressure gradient returned to baseline values within 48 hours after treatment in the endoscopic band ligation group.
In the endoscopic injection sclerotherapy group the hepatic venous pressure gradient remained high during the 120-hour study period.
The team found that the rebleeding rate in the 42-day follow-up period was lower in the endoscopic band ligation group compared with the endoscopic injection sclerotherapy group.
They determined that patients with an initial hepatic venous pressure gradient greater than 16 mm Hg had a greater likelihood of rebleeding, death, and overall failure.
Dr Alec Avgerinos and colleagues concluded, "During acute variceal bleeding endoscopic injection sclerotherapy, but not endoscopic band ligation, causes a sustained increase in hepatic venous pressure gradient, which is followed by a higher rebleeding rate".