Left gastric vein hemodynamics and variceal recurrence in patients undergoing prophylactic endoscopic ligation of high-risk esophageal varices

Background: Early recurrence of esophageal varices remains problematic afte r endoscopic variceal ligation. To evaluate the efficacy of prophylactic en doscopic ligation for esophageal varices at high risk for bleeding, the rel ationship between left gastric vein hemodynamics and variceal recurrence wa s investigated. Methods: Thirty-five patients with cirrhosis underwent endoscopic variceal ligation. Angiography was performed in all patients before treatment and af ter eradication of varices to study left gastric vein hemodynamics. Results: Before treatment, 12 patients had hepatopetal flow in the left gas tric vein (type I), 17 had hepatofugal flow (type II), and 6 had hepatofuga l flow with an extra-esophageal shunt (type III). In type I and III patient s, the direction of blood flow in the left gastric vein did not change afte r eradication of varices. Type II patients showed bi-directional flow in th e left gastric vein after treatment. Varices recurred in all but one type I I patient and in one type I patient during follow-up (mean 36.7 months). Th e 2-year recurrence-free rate was higher In type I patients (p = 0.0001) an d type III patients (p = 0.0002) than in type II patients. Conclusions: Prophylactic ligation seems to be a safe and useful procedure, especially in patients with type I or III hemodynamics in the left gastric vein before treatment.