الفهرس 
OESOPHAGEAL VARICES
BLOOD SUPPLY OF THE LIVEROnly 14 pages are availabe for public view
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Abstract
In Egypt, portal hypertension is the most devastating complication of chronic liver diseases and is the most common cause of mortality and morbidity in patients with liver cirrhosis. Esophageal variceal bleeding (EVB) is a potentially deadly complication in patients with liver cirrhosis and portal hypertension.
The 3-dimensional Doppler ultrasonographic examination is a simple, inexpensive, accurate, and noninvasive technique. It has been widely used to investigate the relationship between EVB and hemodynamics associated with portal hypertension and liver cirrhosis .
This study was designed to clarify the influence of endoscopic variceal band ligation (EVL) on portosystemic shunts evaluated with three-dimentional Doppler ultrasonography before and after band ligation and it’s relation to meal. It was conducted in co-operation between Tropical Medicine department in Faculty of Medicine, Ain Shams University and Radiology Department in the National Hepatology and Tropical Medicine Researches Institute (NHTMRI) in the period from January 2007 to January 2009.
For better assessment, this study was designed to be a randomized blinded controlled study. The current study included 30 with chronic liver disease and portal hypertension (post shistosomal and/or post-viral hepatitis) and with oesophageal varices eligible for band ligation (post bleeding or non-bleeding high risk oesophageal varices with red mark signs).
They were classified into two groups according to the pre-designed inclusion critera; Group A (non bleeders) [Patients with no history of gastrointestinal bleeding in the last three months, index endoscopy showed oesophageal varices grade III or IV, signs of impending rupture of varices at the index endoscopy (cherry red spots, haemocysts, or diffuse redness) and Class (C) by the Pugh’s modification of the Child ’s score.
Group B (Bleeders) [Evident history of upper gastrointestinal bleeding in the last three months (hematemesis and/or melena) but with no history of endoscopic intervention, index endoscopy showed oesophageal varices grade III or IV and no other potential source of bleeding as fundal varices or ulcers and vitally stable at the time of presentation].
All the studied cases were subjected to the following; full history taking, clinical examination, routine laboratory investigations, gastrointestinal endoscopy, abdominal 3-dimensional ultrasonography and Doppler study to assess the diameter, mean velocity, mean blood flow volume, congestion index of LGV and hepatic artery resistive index.
There was male predominance in both groups being 8 male patients (53.3%) and 7 female patients (46.7%) in group A, while 9 male patients (60%) and 6 female patients (40%) in group B. Their age ranged between 35 and 56 years (mean 44.7±9.2 years) in group A. while, In group B, the age ranged between 25 and 52 years (mean 39.74±5.5 years).
There was a highly statistically sinnificance difference between both groups as regards Child Pugh classification.
Concerning LGV heamodynamics’ and HARI study, this was assessed to all patients one day before their first session of EVL (It was done twice; after fasting and postprandial). Then after 7-10 days of the last session of EVL, we measured the same LGV parameters and HARI (also, it was done twice; fasting and postprandial).
Our results showed a highly statistical significant increase in LGV diameter, velocity, mean blood flow and congestion index of the bleeders group compared to the non bleeders in fasting and postprandial examinations. Also, we found that the LGV flow direction was better in the non bleeders group compared to the bleeders’ one in fasting and postprandial examinations.
As regards the Doppler ultrasonographic findings of the hepatic artery, there was statistical significant increase in the HARI of the bleeders group compared to the non bleeders in fasting and postprandial examinations. Also, we found that the non bleeders’ group HARI changes after standard meal were higher compared to the bleeders after EVL with statistically highly significant difference.
After complete obliteration of oesophageal varices by EVL, we found that the non bleeders group responding to the treatment better than the bleeders’ one as regards the previously traced LGV and HARI hemodynamics both in fasting and post postprandial examinations.
When we traced the effect of EVL on the whole studied group hemodynamics, we found a statistically highly significant reduction of the LGV diameter, velocity, mean blood flow, congestion index and HARI after complete obliteration of oesophageal varices. Also, we found that the LGV flow direction was better in the whole studied group after complete obliteration of oesophageal varices