Year 2020 / Volume 112 / Number 6
Original
Hemodynamic changes after endoscopic variceal ligation: a cohort study

456-461

DOI: 10.17235/reed.2020.6656/2019

Nerea Gonzalo Bada, José Manuel Suárez Parga, Teresa Hernández Cabrero, Dolores Ponce Dorrego, Yolanda Zarauza Soto, Marta Abadía Barnó, Antonio Olveira Martín, Joan Novo Torres, Ricardo Rodríguez Díaz, Lucia Fernández Rodríguez, Pedro Mora Sanz, Consuelo Froilán Torres,

Abstract
Background: there is controversy about the need to maintain vasoconstrictor treatment after adequate haemostasis is achieved through endoscopic band ligation (EBL) in bleeding esophageal varices (BEV). Measuring a “before and after urgent-EBL” hepatic venous pressure gradient (HVPG) in acute variceal hemorrhage is very difficult. Thus, the goal of this study was to determine hemodynamic variations after an EBL session. A “before” HVPG (PRE) was performed and another one 24 hours “after-ligation” (POST), in cirrhotic patients undergoing endoscopic band ligation as BEV prophylaxis. Patients and methods: this was a single-center, cohort, prospective study. Patients followed a program of repeated sessions of EBL until eradication of their varices and underwent a basal hepatic venous pressure gradient (PRE HVPG), without changing their usual treatment with beta-blockers. Subsequently, an endoscopic ligation session was performed, following the clinical practices guidelines. A second pressure measurement (POST HVPG) was taken 24 hours after the endoscopic treatment. Results: 30 patients were included. PRE and POST HVPG median results were 16.5 mmHg (14-20) and 19.5 mmHg (17-21), respectively, with a significant increase after the procedure (p < 0.001). Percentage variations in portal pressure, based on the baseline gradient values (12, 16 and 20 mmHg), were higher for patients with a lower basal HVPG versus a higher HVPG for any of the categories compared (p = 0.087, p = 0.016 and p < 0.001, respectively). In our series, 36.7 % of patients showed a ≥ 20 % gradient increase after ligation. Conclusion: endoscopic band ligation causes an increase in portal pressure, at least for a transitional period, determined by the hepatic venous pressure gradient.
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Gonzalo Bada N, Suárez Parga J, Hernández Cabrero T, Ponce Dorrego D, Zarauza Soto Y, Abadía Barnó M, et all. Hemodynamic changes after endoscopic variceal ligation: a cohort study. 6656/2019


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Publication history

Received: 02/10/2019

Accepted: 24/11/2019

Online First: 26/05/2020

Published: 08/06/2020

Article revision time: 41 days

Article Online First time: 237 days

Article editing time: 250 days


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