Does a Change in the Portal Pressure After Endoscopic Variceal Treatment Influence a Long-Term Prognosis?

Abstract

Background and Aim: It is considered that endoscopic variceal treatment influence portal pressure. Increase of portal pressure after treatment could be a risk factor of recurrence. Thus, the aim of this study is to evaluate a change in the portal pressure after treatment will influence a long-term prognosis. Patients and Methods: For this study, 31 patients who were followed at least more than 4 years were selected from 220 patients who had undergone endoscopic sclerotherapy or banding for esophageal varices. Portal pressure was measured before and after treatment by percutaneous direct measure using 21G needle under ultrasound-guidance. Recurrence was determined by endoscopic findings of either new variceal form or appearance of red color sign, including variceal bleeding. Results: Patients divided into two groups, increasing pressure group in 25, and deceasing pressure group in 6. The ratio in changes of portal pressure of before to after treatment was 12.8% in increasing group and −12.0% in decreasing group. The overall rate of recurrence was 30% in 10 years after treatment. In increasing group, the recurrence rate was 23%, 34% in 5, 10 years after treatment. On the other hand, the recurrence rate was 0%, 29% in 5, 10 years in decreasing group. With regard to the survival rate, there was no significant difference between two groups, 92%, 77%, 71% in 3, 5, 10 years in increasing group, 100%, 74%, 49% in 3, 5, 10 years in decreasing group, respectively. No significant difference in recurrence and survival rate between two groups. Conclusion: Although the endoscopic treatment for esophageal varices have an effect on the portal pressure, it does not influence to long-term prognosis. It is considered that endoscopic therapy for esophageal varices has sufficient therapeutic efficacy without being depended on the portal hemodynamic change after variceal treatment.