Esophageal Variceal Ligation Along Or Combined With Histo-adhesive Injection For Gastric And Esophageal Varices:Efficacy And Portal Vain Hemodynamic Changes

Objective To observe the efficacy,the liver function and portal vain hemodynamic changes in patients with gastric and esophageal varices(GEV)treated with esophageal variceal ligation(EVL)along or combined with histo-adhesive injection(EIH-VL).Methods A non-randomized concurrent controlled design was conducted.Patients with decompensated liver cirrhosis and GEV were divided into EIH-VL group(n=21)and EVL group(n=21).The shear wave velocity of liver and spleen were detected by acoustic radiation force impulse imaging,while the diameter and flow velocity of portal vein,splenic vein and left gastric vein were detected by color doppler ultrasonography,the parameters of blood routine,coagulation function and biochemistry analysis was recorded,the Child-pugh scoring was performed before and after treatment.Results The total effective rates of EV / GV in EIH-VL and EVL groups were 66.67% / 52.38% and 42.85% / 23.81%,respectively(P>0.05 both);while the rebleeding rates were 9.52% and 19.05%(P>0.05),respectively.No death was found in both groups.In EIH-VL group,when comparing before and after treatment,the diameter(0.34±0.09 mm v.s.0.27±0.07 mm,P<0.05),blood flow(7.90±4.23cm/s v.s.5.40±3.89cm/s,P<0.05)and flow velocity(17.24±16.50 m L/min v.s.6.70±5.93 m L/min,P<0.05)of left gastric vein in the EIH-VL groups showed a significant declining tendency,while in EVL group the diameter(0.37±0.05 mm v.s.0.36±0.05 mm,P>0.05),blood flow(9.61±4.21cm/s v.s.8.87±3.42cm/s,P>0.05)and flow velocity(18.68±7.29cm/s v.s.17.02±6.13cm/s,P>0.05)of left gastric vein showed no significant differences.The changes of diameter,blood flow and flow velocity of left gastric vein between the two groups before and after treatment were statistically significant(P<0.05),and the decline of EIH-VL group was greater than that of EVL group(P<0.05).No significant differences were found in the diameter,blood flow and flow velocity of portal vein and splenic vein,the size and the shear wave velocity of liver and spleen,as well as the liver function.The patients were followed up for half a year and no obvious complications were found.Conclusion EIH combined with EVL is safer and more effective than EVL only,and has no significant impact on the hemodynamics of portal system and the liver function.