EFFECT OF ENDOSCOPIC VARICEAL SCLEROTHERAPY ON ESOPHAGEAL MOTOR FUNCTIONS AND GASTROESOPHAGEAL REFLUX

Sclerotherapy results in significant local complications, both immedia te and delayed. This study was designed to examine the esophageal path ophysiology underlying these complications. Methods: We prospectively evaluated esophageal transit, motility abnormalities and gastroesophag eal reflux (GER) with barium studies and esophageal functional scintig raphy in 24 patients (20 men, 4 women; mean age 33 +/- 12.4 yr) before sclerotherapy (Phase I), after two sessions (Phase II), following var iceal eradication (Phase III) and 4 wk later (Phase IV). Results: Vari ces were obliterated after 5.6 +/- 1.9 sessions of intravariceal scler otherapy performed weekly with 1% polidocanol (17.3 mi per session). T here was no baseline Phase I dysmotility or reflux. Phase II studies r ecorded a marked delay of esophageal global and segmental (mid and dis tal) transit time in 98.2% of patients by scintigraphy and 90% by bari um studies. Incoordinate contractions and aperistalsis were observed i n 0, 66.7%, 58.3% and 33.8% of patients from Phases I-IV studies, resp ectively. Barium studies revealed tertiary waves and reverse peristals is in 0, 50%, and 75% of patients from Phases I-III; strictures were o bserved in 0, 1, and 3 patients during Phases I-III. GER was detected scintigraphically in 0, 58.3%, 25% and 16.6% during Phases I-IV sequen tially. In contrast, barium studies grossly underestimated GER (0, 5% and 15% at phases I-III). Conclusion: There was strong concordance bet ween esophageal symptoms, transit, motility abnormalities and GER (p < 0.05). Variceal eradication (Phases III and IV) was associated with a gradual recovery of esophageal symptoms, ulcers and all abnormal scin tigraphic parameters. Sclerosant-induced chemical esophagitis in assoc iation with peptic esophagitis due to gross reflux following sclerothe rapy possibly can explain the symptoms in most patients.