Endoscopic Variceal Sequential Ligation Does Not Increase Risk of Gastroesophageal Reflux Disease in Cirrhosis Patients.

Abstract

BACKGROUND:

Endoscopic variceal sequential ligation (EVSL) is currently endorsed in our hospital, as the preferred endoscopic treatment for prevention of variceal rebleeding and achieving adequate hemostasis. There is currently a lack of consensus surrounding EVSL-induced changes in esophageal motor function and abnormal reflux.

AIMS:

To explore alterations in esophageal motor function and risk of abnormal gastroesophageal reflux in liver cirrhosis patients with esophageal varices, after EVSL.

METHODS:

Twenty-one liver cirrhosis patients with esophageal varices were studied using manometry and 24-h pH monitoring 1 day prior to and 1 month following EVSL. The EVSL consisted of performing esophageal variceal ligation using a multi-band ligator, which was repeated every 4 weeks until the varices were eradicated.

RESULTS:

The amplitude and duration of peristaltic contraction waves and the percentage of abnormal esophageal contraction waveforms were unaltered in both the proximal (P > 0.05) and the distal (P > 0.05) esophagus after EVSL. However, the lower esophageal sphincter pressure was decreased following EVSL (16.1 ± 7.9 mmHg vs 21.1 ± 6.3 mmHg (P < 0.05)). Various quantitative parameters including percentage of total monitoring time with pH < 4.0, total number of reflux episodes, number of reflux episodes > 5 min, and DeMeester scores were not increased in post-EVSL patients. Abnormal reflux monitored by 24-h pH monitoring occurred in ten (47.6%) pre-EVSL patients and 11 (52.4%) post-EVSL patients.

CONCLUSIONS:

Although EVSL affects esophageal motility by relatively decreasing LES pressure, it does not induce substantial motor abnormalities nor increase risk of abnormal gastroesophageal reflux disease in cirrhosis patients.

• Authors: Jin Tao, JianZhong Li, XiaoLiang Chen, YunWei Guo, Hong Tian, XiuQing Wei, FengPing Zheng, ZhuoFu Wen, Bin Wu
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 65 Issue 1 Pg. 329-335 (01 2020) ISSN: 1573-2568 [Electronic] United States
• PMID: 31332625 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Esophageal and Gastric Varices (diagnosis, etiology, surgery)
• Esophagoscopy (adverse effects)
• Female
• Gastroesophageal Reflux (diagnosis, etiology, physiopathology)
• Gastrointestinal Hemorrhage (diagnosis, etiology, prevention & control)
• Hemostatic Techniques (adverse effects)
• Humans
• Ligation (adverse effects)
• Liver Cirrhosis (complications, diagnosis)
• Male
• Middle Aged
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome