Evaluation of some pulmonary functions and pleuropulmonary complications after endoscopic sclerotherapy of gastric fundal varices at Zagazig university hospitals

Abstract

BackgroundIncidence of gastric fundal varices is about 16–70% of patients with portal hypertension. It causes upper gastrointestinal bleeding in about 10–15% of cases. There are different methods used for the management of gastric varices. Endoscopic injection of N-Butyl-Cyanoacrylate (NBCA) is considered to be the choice for control of active bleeding from gastric varices. Pulmonary complications of sclerotherapy are common and varying from minor complications to severe complications as pleural effusion, lung collapse, consolidation, adult respiratory distress syndrome and pulmonary embolism. AimTo evaluate pulmonary functions after endoscopic sclerotherapy of gastric fundal varices by N-Butyl-Cyanoacrylate and the effect of incentive spirometry (IS) on post sclerotherapy pulmonary functions. MethodsSixty patients with liver cirrhosis and portal hypertension were included in the study. All patients were subjected to full history and careful clinical examination, upper GI endoscopy, Child-Turcotte-Pugh classification, chest X-ray and high resolution CT chest with contrast on the day just before endoscopy and within 48h post procedure, ABGs and spirometry for FVC (%pred), FEV1 (%pred), FEV1/FVC%, FEF 25–75 (%pred) and PEFR (%pred) 6h before and 2days after GI endoscopy. Patients were divided into two groups according to the result of upper GI endoscopy: Group 1: included 30 patients with liver cirrhosis and portal hypertension, with upper GI endoscopy revealed gastric fundal varices and injection sclerotherapy with NBCA was done; Group 2: included 30 patients with liver cirrhosis and portal hypertension with upper GI endoscopy showed no gastric fundal varices or non risky, small sized fundal varices which were not injected. G1 was further divided randomly into 2 subgroups (G1a and G1b) with measurement of ABGs and spirometry parameters after application of incentive spirometry. Results16.67% and 6.67% of patients in group (1) developed pleural effusion and atelectatic bands of the lung respectively after sclerotherapy. There was a statistically significant decrease in PaO2, FVC (%pred), FEV1 (%pred) and FEF 25–75 (%pred) in group (1) after sclerotherapy from 80.12±12.91, 98.25±10.74, 90.86±4.21 and 82.12±29.21 to 71.96±19.89, 82.11±9.61, 75.65±3.15 and 50.03±20.11 respectively. The deteriorated parameters in G1a was improved after the application of incentive spirometry for 2days regarding PaO2, SaO2, FVC, FEV1 and FEF 25–75 from 69.91±17.93, 90.01±3.84, 80.27±8.71, 75.12±1.96, 52.14±19.24 to 83.23±19.07, 97.85±5.72, 88.97±9.94, 87.01±1.03, 72.91±18.13, respectively, on the other hand, there was a non significant statistical difference in all parameters of G1b. Also, there was a significant correlation between numbers of NBCA ampoules used for sclerotherapy and decrease in Post procedure PaO2, Post FEV1 (%pred), Post FVC (%pred) and Post FEF 25–75 (%pred). ConclusionsNBCA injection of gastric fundal varices was associated with significant, reversible deterioration in some pulmonary functions, atelectasis and minimal pleural effusion with significant rapid improvement if incentive spirometry is used.