Abstract
The effect of increased portal blood flow by intravenous glucagon injection on endoscopic findings of the esophageal varices was studied in patients with liver cirrhosis. In 22 patients with liver cirrhosis complicated with esophageal varices, endoscopy was performed after overnight fasting. Soon after routine observation of the esophagus, 1USP unit of glucagon was injected intravenously. Endoscopic findings of the esophagus were continuously observed and photographed before, during and after intravenous glucagon adminis-tration. In 11 patients, repeated examination was performed after endoscopic injection sclerotherapy of the varices. After glucagon administration, some variceal veins were engorged (Figure 1, 2), and reddish hue was increased (Figure 3, 4). Mucosal fine vascular networks were accentuated (Figure 2, 3). Cherry red spots were enlarged, and increased in number (Figure 5, 6). Red wale marking also showed similar change (Figure 5). Diffuse redness was increased in color after glucagon administration (Figure 7). A bleeding from a hematocystic spot was noted after glucagon administration in one case (Figure 8). Engorgement of varices was observed in 15 patients (68%), and increase in variceal redness was seen in 7 (32%). Fine vascular network was increased after injection in 11 patients (50%), and red color sign was accentuated in 7 (32%). In cases with successful endoscopic injection sclerotherapy, no change in figure or color of collapsed variceal veins was noted after glucagon injection. On the other hand, an engorgement of varices was observed after glucagon administration in some cases, suggesting patent lumen of the varices. Endoscopic observation of change in esophageal varices after intravenous administration of glucagon is useful to evaluate the participation of portal blood flow to the formation of varices. It is also applicable to evaluate the effectiveness of endoscopic injection sclerotherapy.
