Influence of endoscopic variceal ligation on oesophageal motility

Background: To determine the change of oesophageal manometry in patients wi th oesophageal varices before and after oesophageal variceal ligation (EVL) . Methods: Forty-five patients who had liver cirrhosis and oesophageal varice s with high risk of bleeding were managed by EVL. Oesophageal manometry was performed just prior to the ligation and 4-6 weeks after obliteration of v arices. Another 45 age- and sex-matched patients without hepatic, oesophage al or systemic disease served as the control group. Results: At 5 cm above the lower oesophageal sphincter (LES), the amplitude of the contractive wave was significantly lower in patients before EVL (56 .9 +/- 31.8 vs 80.1 +/- 30.1, P < 0.05) and returned to the level of contro l subjects after EVL (76.5 +/- 37.0 vs 80.1 +/- 30.1, P>0.05). At 10 cm abo ve LES, the amplitude of the contractive wave was significantly lower in pa tients before and after EVL than the control group (54.3 +/- 29.2 vs 68.1 /- 29.5, 54.2+/-26.0 vs 68.1 +/- 29.5, respectively, P<0.05). The percentag e of tertiary waves was significantly higher in patients before and after E VL than in the control group (31.4+/-36.6 vs 5.8 +/- 15.1, 26.9 +/- 32.9 vs 5.8 +/- 15.1, respectively, P<0.05). However, no significant swallowing di sturbance was noted in patients after EVL. There was significantly greater LES length in patients before EVL (4.0 +/- 0.9 vs 3.4+/-0.7, P<0.05) but th ere was no significant difference in the LES length after EVL as compared w ith the control group. Eighty-six per cent (39/45) of patients developed pa raoesophageal varices and 31% (14/45) developed new varices 6 months after variceal obliteration. However, there was no significant difference in mano metry at the time of variceal obliteration between patients with variceal r ecurrence and those without. Conclusions: The presence of varices affected oesophageal motility. However , such abnormality had little clinical significance. Endoscopic variceal li gation normalized oesophageal motility and may not induce abnormal oesophag eal motility. The manometric change can not be used to predict the recurren ce of varices in cirrhotic patients after variceal obliteration.