Study of oesophageal motility in Egyptian cirrhotic patients before and after prophylactic endoscopic variceal ligation

ABSTRACT

The aim of this work is to study oesophageal motility in non bleeding cirrhotic patients before and after endoscopic ligation of oesophageal varices. This study was conducted on 90 subjects as follows Group [I] 50 patients with liver cirrhosis and large oesophageal varices [i.e. grade III, IV]. Group [II] 20 patients diagnosed with liver cirrhosis but without oesophageal varices. Group [III] 20 healthy volunteers. Written informed consent was obtained from all subjects. Complete laboratory investigations were done as well as abdominal ultrasonography, upper endoscopy and oesophageal motility was done by stationary and rapid pull through manometery using a low compliance pneumohydraulic perfusion system. EVL was done in 50 patients [Group I]. Oesophageal motility before EVL revealed that there was a significant decrease in the amplitude of the contractive wave at the middle and the distal oesophagus and there was an increase in the wave velocity in the distal oesophagus with significant increase in the abnormal waves with no effect on wave duration. Ascites had no effect on the oesophageal motility and the LES pressure; also there was no significant difference in patients in terms of Child Pugh grading. Oesophageal motility after EVL revealed no significant decrease in the amplitude of the contractive wave at the middle oesophagus, and the decreased amplitude in the distal oesophagus before EVL was returned to the level of normal healthy control. Also, there was increase in the velocity of wave after EVL in the distal oesophagus with no effect on wave duration. Prophylactic EVL is an effective method for primary prophylaxis of oesophageal varices with no serious complications. EVL normalized oesophageal motility and if it induced abnormal oesophageal motility, it was of little clinical significance and reversible