effect of injection sclerotherapy on the progress of the underlying liver pathology and portal hypertension

ABSTRACT

Fifty patients presenting with acute variceal bleeding received sclerotherapy with the aim of obliterating their varices and were followed up for one year. The effect of sclerotherapy on the portal pressure and the liver pathology was recorded. The portal vein diameter was measured by real time ultrasonography as an indirect index of the portal pressure. The underlying liver pathology was determined by percutaneous liver biopsy. Bleeding was controlled in 90% of the patients at the end of one month. Twelve patients had recurrence of bleeding and the final control of bleeding was 84.1%. The one-year survival rate was 80%, which was not significantly influenced by the size of the liver nor the spleen. The type of liver pathology had no significant effect on the survival. The portal vein diameter taken as an index of the portal pressure [mean 1.57 +/- 0.22 cm] showed no significant change after the completion of sclerotherapy [mean 1.56 +/- 0.198 cm]. The different parameters of liver functions were compared before and after sclerotherapy and no detectable difference was observed that could be ascribed to the injection procedure. In fact, the mean Child's score improved significantly from 6.73 +/- 0.94 to 5.92 +/- 0.90 points after sclerotherapy. The type and extent of liver pathology present [1/5 cirrhosis, 2/5 bilharzial and 2/5 mixed] showed no change after sclerotherapy indicating the absence of any toxic effect of the sclerosant on the liver. It was concluded that injection sclerotherapy shown to be an effective method of controlling variceal bleeding which did not interfere with the portal bleed flow to the liver and has no deleterious after-effects on the liver parenchyma