Japanese Journal of Portal Hypertension and Esophageal Varices

A recurrence rate of esophageal varices after endoscopic variceal ligation (EVL) therapy was compared with combined EVL and endoscopic injection sclerotherapy (EIS). In recent 5 years 16 patients with esophageal varices were treated by EVL alone (EVL group) and 14 patients were treated by EVL combined with 1% endoscopic injection sclerotherapy with Aethoxysklerol (AS-EIS) (EVL+EIS group). Although an eradication rate of F₃ varices was higher in EVL+EIS group than in EVL group (83.3% vs 25.0%), the differences of recurrence rate (42.9% vs 37.5%) and 3 year cumulative recurrence free rate (50.0% vs 58.3%) were not significant between the two groups. The recurrent varices were eradicated by average 1.8 sessions of 1% AS-EIS or EVL. Neither bleeding nor recurrence was observed after the treatment. Esophageal variceal pressure (EVP), which is reported to be closely related to variceal rupture, was measured before the initial treatment in 12 patients. The mean EVP of patients with recurrence was higher than that of recurrence free patients (23.5 ± 7.1 mmHg vs 16.0 ± 7.1 mmHg) and 6 of 8 patients whose EVP were higher than 15.0 mmHg experienced variceal recurrence. It is concluded that EVL alone and combined EVL and EIS are not different in terms of variceal recurrence, and EVP is valuable to predict variceal recurrence and patient who show high EVP should be followed strictly.

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Partial ligation of extrahepatic portal vein of rats was conducted in order to clarify hemodynamic changes of hepatofugal collateral pathways at early stage of extrahepatic portal obstruction. Measurement of extrahepatic portal pressure, portography and pathologic examination on trans-lucent specimen of the esophagus were performed immediately after ligation, and on 3rd day and 7th day after the operation. The hepatofugal collateral pathways were classified into three patterns : (A) paraesophageal veins, (B) collateral pathways with flow into left adrenal vein and renal vein, and (C) collateral pathway with backflow to inferior mesenteric vein. Detectability of these three pathways and spleen was evaluated on portogram. Every three collateral pathways became obvious on the 3rd day after the ligation and markedly developed on the 7th day. Especially, dilatation of paraesophageal vein and submucosal vein were confirmed with translucent specimens. In contrast, depiction of the spleen became obscure. This phenomenon was interpreted as a consequence of development of the collaterals. Maximum extrahepatic portal pressure was recorded on the 3rd day, and it descended on the 7th day, probably due to development of the collaterals. The present experimental study indicated that sudden extrahepatic portal obstruction triggered the formation of collateral pathways as early as within a week.

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