THE EFFECTS OF CHRONIC ENDOSCOPIC VARICEAL SCLEROTHERAPY ON SYSTEMIC AND SPLANCHNIC HEMODYNAMICS IN PATIENTS WITH CIRRHOSIS

The aim of this study was to determine whether endoscopic variceal scl erotherapy affects systemic or splanchnic hemodynamics. We measured he modynamic parameters before and after the first course of sclerotherap y in 35 patients with cirrhosis. Following sclerotherapy, there was a significant decrease in cardiac index and a significant increase in sy stemic vascular resistance. Changes in hepatic venous pressure gt adie nt varied from patient to patient with no statistically significant ch ange in the group overall. However, all 20 patients with a decline in the hepatic venous pressure gradient had a concomitant decrease in car diac index and/or a large extravariceal shunt. The multivariate analys is disclosed that the decrease in cardiac index was a statistically si gnificant contributor for the decline in hepatic venous pressure gradi ent. We conclude that the obliteration of esophageal varices by sclero therapy significantly reverses the hyperdynamic circulatory state in p atients with cirrhosis. Spontaneous changes in systemic hemodynamics a nd the interaction with hepatic hemodynamics must be taken into accoun t when evaluating hepatic hemodynamics in patients undergoing variceal sclerotherapy.