Assessment of hemodynamic changes in portal circulation by doppler sonography after endoscopic sclerotherapy

ABSTRACT

To determine the effect of endoscopic variceal sclerotherapy [ES] on the hemodynamic of portal venous system, 40 patients with intrahepatic cause of portal hypertension and bleeding oesophageal varices [OV] were enrolled in this study. Assessment of main portal vein [MPV], its right and left branches [RPV], [LPV], splenic vein [SV] and superior mesenteric vein [SMV] by duplex [DU] and color coded Doppler sonography [CCDS] were done before and after complete obliteration of OV by ES to determine their diameters, patency, pattern and direction of flow, blood flow velocity, blood flow volume and congestion index. 28 patient were effectively treated by ES, 5 cases died after uncontrolled hemorrhage and 7 cases escaped before complete obliteration of OV. Coronary veins showed no flow in 65% of cases after ES. Incidence of reappearance of OV and recurrent attacks of bleeding were significantly lower in these cases than those with patent one. Child-Pugh's classification and hemodynamic parameters of studied vessels showed insignificant difference before and after complete obliteration of OV. We found that Duplex and CCDS are valuable, rapid, noninvasive screening procedure for monitoring hemodynamics of portal venous system. ES seems to be suitable method for patient with PH and bleeding OV. It preserves the relationship between the factors interacting in the portal venous system hemodynamic