Short-term portal hemodynamic effects of endoscopic embolization for esophageal varices

Background/Aim: Endoscopic embolization (EE) is a specialized treatment tha t obliterates esophageal varices along with their associated blood supply. The purpose of this study was to investigate the short-term effects of EE f or esophageal varices on portal hemodynamics and liver function. Methods: T hirty patients with esophageal varices were included in this study. The por tal blood flow was measured by an ultrasonic duplex Doppler system before a nd after EE. EE was performed by freehand intravariceal injection of 5% eth anolamine oleate with iopamidol with the aid of a balloon attached to the t ip of an endoscope under fluoroscopy. Results: For the blood supply system, endoscopic varicography at the time of EE was able to show the vessels of the cardiac branch of the left gastric vein in 93% of the cases, the cardia c venous plexus in 90%, the trunk of the left gastric vein in 27%, the less er curvature branch of the left gastric vein in 10%, the fundic branch of t he short gastric vein in 13%, and the posterior gastric vein in 13%. For th e blood drainage system, endoscopic varicography was able to show the parae sophageal vein in 39% of the cases, the inferior phrenic vein in 17%, and t he mediastinal vein in 13%. No clotting was detected after EE in the intra- and extraportal veins in any of the cases. The flow velocities in the main portal vein before and after EE were 14.2 +/- 3.2 and 15.5 +/- 3.5 cm/s, r espectively, showing no significant change. The cross-sectional area of the portal vein before and after EE was 0.96 +/- 0.21 and 1.04 +/- 0.23 cm(2), and the flow volume of the portal vein was 817 +/- 288 and 930 +/- 189 ml/ min, both also showing no significant change. The blood laboratory paramete rs showed no significant change after EE. Conclusions: We conclude that nei ther portal blood flow nor liver function were damaged by EE, although both the varices and their associated blood supply were obliterated. Copyright (C) 2000 S. Karger AG. Basel.