Aim: Hemodynamic changes in hepatic blood flow after endoscopic injection sclerotherapy (EIS) compared to the baseline blood flow are to be elucidated in patients with cirrhosis both due to alcohol consumption and hepatitis C virus (HCV) infection. Thus, hepatic arterial tissue blood flow (HATBF) and portal venous tissue blood flow (PVTBF) were evaluated by xenon computed tomography (Xe-CT) in patients with cirrhosis receiving EIS for esophagogastric varices (EGV).

Methods: Subjects were 18 patients with alcoholic cirrhosis and 19 patients with of HCV-related cirrhosis receiving EIS for EGV. Xe-CT was performed before and after EIS procedures. Total hepatic TBF (THTBF), splenic blood flow and PVTBF/HATBF (P/A) ratio were calculated.

Results: PVTBF (ml/100 ml/min; mean±SD) before and after EIS procedures were 25.6±6.3 and 29.8±6.2, respectively, in patients with alcoholic cirrhosis, and 28.9±9.4 and 29.2±8.7, respectively, in patients with HCV-related cirrhosis; the values were increased significantly in the former patients (p=0.006), while were not altered in the latter patients. In contrast, HATBF, THTBF and P/A ratios were not changed after EIS procedures compared to baseline values.

Conclusions: Portal venous flows were increased especially in patients with alcoholic cirrhosis after EIS procedures compared to those at baseline, and abstinence after admission might contribute to such hemodynamic changes.

While balloon-occluded retrograde transvenous obliteration (B-RTO) is useful as a procedure for management of hepatic encephalopathy, ascites as well as esophageal varices may be aggravated in frequent due to elevation of portal venous pressure following complete obliteration of portosystemic shunts. Thus, usefulness of partial B-RTO procedures using a loose ball of non-fibered interlocking detachable coil (IDC) was retrospectively evaluated in patients with intractable hepatic encephalopathy. Subjects were 11 patients with portosystemic shunts carrying the left renal vain as a drainage vessel, and were classified into 6 patients receiving partial B-RTO procedures and 5 patients in whom conventional B-RTO procedures using 5% ethanolamine oleate iopamidol were done. Hepatic encephalopathy was attenuated in 5 among 6 patients receiving partial B-RTO procedures, while frequency of hepatic encephalopathy occurrence and duration of hospitalization were decreased in the remaining 1 patient. Serum ammonia levels were significantly decreased after the procedures compared to the baseline levels in both groups (p<0.05), and a reduction rate of the levels after the procedures relative to the baseline levels were 42.0% in the partial B-RTO group, which was equivalent to the rate (48.6%) in the conventional B-RTO group. In the conventional B-RTO group, intractable ascites developed in 1 patient and esophageal varices were aggravated leading to rupture in an another patient, while such complications were absent in all patients receiving partial B-RTO procedures. Partial B-RTO procedures may prevent development of overt hepatic encephalopathy through decrease of blood flow in portosystemic shunts without excess elevation of the portal venous pressure. In conclusion, partial B-RTO procedures were effective and safe as therapeutic devises for hepatic encephalopathy due to portosystemic shunts, and may contribute to improve quality of life of patients.

When danaparoid sodium was given to 15 cirrhotic patients complicated with portal vein thrombosis (Child-Pugh classification A: B: C=3, 11, 1 patients), results of the treatment were as follows: the thrombosis disappeared in 2 patients, reduced in 10, and remained unchanged in 3; in total, 12 of 15 patients (80.0%) showed disappearance/reduction of thrombosis. Thrombosis remained unchanged in cases where portal vein thrombosis was accompanied by cavernous transformation. Moreover, among the patients who did not receive warfarin treatment, 2 out of 7 patients showed enlargement of portal vein thrombosis, and 3 of 11 patients experienced aggravation of the symptoms. In contrast, 4 patients who received maintenance therapy with warfarin did not show enlargement of portal vein thrombosis or worsening symptoms. These results suggest that danaparoid sodium would be generally effective for portal vein thrombosis. However, treatment efficacy was not expected in cases with chronic and organized portal vein thrombosis with cavernous transformation. In such cases, maintenance therapy with warfarin would be applicable to prevent recurrence and/or worsening of portal vein thrombosis.