Effect of endoscopic sclerotherapy of esophageal varices on vagus nerve integrity

Abstract

Endoscopic sclerotherapy is an effective method of controlling variceal hemorrhage, but complications frequently occur. Recent studies have shown that sclerotherapy may induce transient alterations in gastrointestinal motility. It has been suggested that these complications result from vagal nerve injury due to sclerotherapy. We have tested this hypothesis by measuring pancreatic polypeptide secretion in response to insulin-induced hypoglycemia (insulin 0.1 U/kg i.v.), a well-known stimulus for vagal nerve function. We studied six patients with cirrhosis and variceal bleeding (group A, mean age 52 years) on two occasions, before and 3 days after the first sclerotherapy. In addition six other patients with cirrhosis (group B, mean age 51 years) 6 months after successful repeated sclerotherapy for esophageal varices and 12 control subjects (mean age 50 years) were investigated. Basal plasma pancreatic polypeptide concentrations were not significantly different between group A patients before sclerotherapy (28 +/- 4 pM) or after sclerotherapy (24 +/- 6 pM), group B patients (40 +/- 9 pM) and controls (29 +/- 4 pM). Although the plasma pancreatic polypeptide peak increment in response to insulin hypoglycemia was reduced in group A patients after sclerotherapy (90 +/- 35 pM) compared to pre-sclerotherapy (120 +/- 18 pM), to group B patients (146 +/- 20 pM) and to controls (143 +/- 7 pM), this difference was not significant. Nor did sclerotherapy significantly reduce the integrated pancreatic polypeptide secretion between or within groups. However, in two group A patients a transient and reversible reduction in pancreatic polypeptide secretion was observed directly after sclerotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)