EFFECTS OF ENDOSCOPIC VARICEAL LIGATION ON OXYGEN-TRANSPORT AND THE ARTERIAL LACTATE LEVELS IN PATIENTS WITH CIRRHOSIS

Objective: Despite the increased cardiac output and oxygen delivery, a n impaired oxygen uptake has been noted in patients with cirrhosis, We recently observed that endoscopic variceal ligation decreased the car diac output due to a reduction in the cardiac preload, It is thus poss ible that a variceal ligation decreases the oxygen delivery and thereb y negatively influences tissue oxygenation in patients receiving such treatment. We thus investigated the effects of variceal ligation on ox ygen delivery, oxygen uptake, and the arterial lactate levels. Methods : There were 22 patients with compensated cirrhosis and risky esophage al varices (Child's class A:B = 13:9), Twelve patients underwent an en doscopic variceal Ligation and 10 patients received gastroscopy as a c ontrol. The cardiac function, blood gas status, oxygen delivery, and a rterial lactate concentration were also assessed before and after vari ceal ligation, The oxygen uptake was calculated by the Fick equation, Results: Following variceal ligation, there was an immediate decrease in the cardiac output and oxygen delivery. The reduction in oxygen del ivery was associated with a slight but significant increase in the art erial lactate concentration. The decreased oxygen delivery was also as sociated with a concomitant decrease in the oxygen uptake. In the cont rol subjects, gastroscopy did not alter the systemic hemodynamics, art erial oxygen status, or arterial lactate levels. Conclusion: We found a significant decrease in the oxygen delivery in patients undergoing a n endoscopic variceal ligation, Such deteriorated tissue oxygenation m ay be serious especially in patients with a low oxygen transport abili ty such as in patients with variceal hemorrhage with anemia. However, the clinical significance of these changes remains unclear and further studies are therefore warranted. (Am J Gastroenterol 1998;93:1340-134 5. (C) 1998 by Am. Cell. of Gastroenterology).