Short-term effects of variceal sclerotherapy on portal hypertensive gastropathy.

BACKGROUND AND STUDY AIMS: Obliteration of esophageal varices may modify the mucosal perfusion of the stomach. The relationship between short-term injection variceal sclerotherapy (IVS) and the evolution of portal hypertensive gastropathy (PHG) is insufficiently recognized.

PATIENTS AND

METHODS

Forty-one cirrhotic patients were treated with hemostatic or secondary preventive IVS. They underwent sclerotherapy at intervals of four to five days until esophageal ulceration, stricture, or a reduction in variceal size developed. On admission and on completing the IVS schedule, an endoscopy score was calculated using a system assigning 0 points for a normal mucosal image, 1 point for reddened, 2 points for a mosaic-like mucosal pattern, and 3 points for a mosaic-like pattern plus red marks in the stomach. All patients received propranolol after the first sclerotherapy session.

RESULTS

The total score before IVS was 45 points (1.1 points per patient). After 188 sclerotherapy sessions (2-8 per patient), the score significantly increased to 73 points (1.8 points per patient, P = 0.04). This effect was particularly marked in Child-Pugh class B patients (mean individual rise from 0.7 to 1.9 points, P = 0.01), and negligible in patients with either less or more advanced cirrhosis (Child-Pugh classes A and C).

CONCLUSIONS

In patients with cirrhosis, short-term IVS may contribute to the mechanisms of progressive PHG.