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PubMed1999

[The role of endoscopic ligation in the management of esophageal varices and rupture].

In the last two decades sclerotherapy has became one of the most widespread procedures in the palliative therapy of esophageal varicosity and rupture. Beside many of its advantages, there are high numbers of local and general complications. The new ligation method is very effective, but less invasive and free from side effects. The single shot method in spite of using overtube is slower, unpleasant and not free from risks. The new six shooter system, which uses 6 rubber-bands eliminates these disadvantages. This technique was introduced the first time in Hungary by the authors. They performed ligations between June 1997 and June 1999 on 39 random patients, 55 times. 41 times due to rupture of varices, 8 times in no-bleeding periods for eradication of varices, 6 times for prophylaxis. The average age was 51 (27-75), 32 men and 7 women participating. The cause of esophageal varicosity was thrombosis of vena portae in 1 patient and cirrhosis in others. The background of the cirrhosis was alcohol in all cases except for one which was due to alcohol and hepatitis C in addition. Altogether 346 rubber-bands were applied. The average ligation was 6.3 (3-17) per patient and 4.5 (3-6) per session. The 41 ruptures of the 32 patients were treated with 80 units of blood, not including one patient given 29 units of blood who had mortal haemorrhage. It means 2.5 units of blood per patient and 2 units per varix rupture. After ligation patients had no complaints except for retrosternal discomfort in some patients. There were no complications observed. The mortality rate was 5 out of 32 one patient died due to bleeding. The follow up of the ligation was carried out by endoscopy and in the 4 dead patients by pathological procedures. The ligation method which was applied by the authors is effective, faster and has less complications in varix irradications than sclerotherapy. The prophylactic therapy of high risk patients and other therapeutic indications can contribute to its wider utilization.

Adult↗
PubMed2000

An immunocytochemical profile of the endocrine pancreas using an occlusive duct ligation model.

CONTEXT: Ligation of the pancreatic duct, distally to its confluence into the bile duct has been shown to induce endocrine tissue regeneration. The surplus endocrine tissue formed is presumed to be able to replace pathologically and/or experimentally compromised tissue. OBJECTIVE: This is a quantitative study on the histology of duct ligated pancreas employing immunocytochemistry and computerised morphometry. INTERVENTIONS: Pancreatic duct ligation was performed on 25 groups of six normal Sprague-Dawley rats. Experimental animals were sacrificed at 12-hour intervals from day one to ten post-duct ligation and every 24 hours thereafter to day 14, the pancreas removed, fixed and processed. Six consecutive 3-6 micron serial sections were cut on a rotary hand microtome, floated onto 3-aminopropyl-trimethoxysilan coated slides and alternatively immunocytochemically stained for insulin, glucagon, pancreatic polypeptide and somatostatin. RESULTS: Pancreas transformation between days 1/2 and 3 1/2 was characterised by acinar deletion and the appearance of immunoreactive cells for the primary endocrine hormones. Transdifferentiation of existing endocrine tissue saw islet insulin core cells replaced by pancreatic polypeptide- and somatostatin positive cells, glucagon deletion and random appearance of all endocrine cell types within the inter-islet interstitium by day 3 1/2. Days 4 to 14 were characterised by cellular migration and islet reconstruction. CONCLUSIONS: To date our laboratory has investigated transplantation of foetal tissue beneath the renal capsule in syngeneic, isogeneic and allogeneic normal and diabetic rats. As pancreatic duct ligation induces the development of surplus endocrine tissue our next step would be to investigate the use of ligated pancreas as a replacement for foetal tissue.

Animals↗
PubMed2001

Results of rubber band ligation of esophageal varices.

BACKGROUND: The aim of the paper is to analyze the results of endoscopic rubber band ligation of esophageal varices performed between 1 January 1998 and 1 November 2000 at the Department of GI Surgery of 4th Military University Hospital. MATERIAL AND METHODS: Cases of 50 patients with massive upper GI variceal bleeding present on admission or with the history of such a bleeding were reviewed. A total of 85 endoscopic procedures of rubber band ligation were performed. In 9 (18%) cases ligation was performed due to massive variceal bleeding, in 1 case the complementary obliteration of stomach fundus varices with Aethoxysclerol was performed. In 10 (20%) cases in grade C of Child-Pough scale of liver failure, 3 endoscopic procedures were performed, in 15 (30%) in grade B--2 procedures, in the remaining 25 (50%) cases, also in grade B--1 procedure was performed. Procedures were conducted with Wilson-Cook Multi-Band Ligator SAEED SixShooter. RESULTS: In all cases with non-bleeding esophageal varices the overall good result of treatment was achieved, with collapsing of variceal columns. In 8 (88.8%) of 9 cases treated due to variceal bleeding, good hemostasis was achieved and no reintervention was necessary. In 1 case of massive variceal bleeding endoscopic treatment failed and patient eventually died. In 25 (50%) cases the complementary (1 or 2) rubber band ligations were performed. Follow-up period has ranged from 1 to 34 months. No cases of severe complications after the procedure were noted. In early period after the procedure 43 (86%) patients complained of transient, mild retrosternal pain and mild to moderate dysphagia. CONCLUSIONS: Endoscopic rubber band ligation is a safe and effective treatment for esophageal varices both in cases of variceal bleeding and as elective procedure.

Adult↗
PubMed1975

The effect of ligation of cauda epididymidis and vasectomy on testicular function in the adult gerbil (Meriones hurrianae).

1. The effects of ligation of caput, cauda epididymides and vasectomy were studied in adult gerbils. 2. The operations were performed unilaterally, the testis and epididymides on the contralateral side serving as controls. 3. Ligation of cauda epididymides decrease testicular weight, whereas caput ligation did not change the testis weight. Accessory sex glands were reduced in size. 4. Ligation caused a drastic degeneration of the spermatogenic cells. There was a complete disruption of testicular function. Leydig cell hypertrophy was conspicuous. Caput and cauda ligation led to degenerative changes in the epididymides. Epididymal epithelium was regressed and the lumen was devoid of spermatozoa. 5. Caput and cauda ligation inhibited the synthesis of RNA, protein and sialic acid in testis and epididymides and depleted the fructose concentration in the seminal vesicle. 6. Vasectomy did not cause any alteration in sperm production during the 8 week period on the lighted side. The cytology and the biochemistry of the testis and epididymides appeared to be normal.

Age Factors↗
PubMed1960

Treatment of spontaneous tumours by temporary local ligation. A comparative study in dogs.

Previous work in some human cases and in laboratory animals has indicated that temporary local ligation of spontaneous tumours has a selective destructive effect on these tumours, with only temporary inflammation resulting in normal tissues. In the experiments described in this paper, 49 spontaneous accessible tumours in dogs were treated by this method, with periods of ligation of from 4 to 11 hours. Success, as measured by selective necrosis of tumour tissue as compared with normal tissue, was achieved in 29 out of 41 benign tumours, including lipomas, angiomas, adenomas and mixed mammary tumours. Treatment failures were encountered in two cases each of papillomas and fibromas, six mixed mammary tumours and two testicular tumours. Total necrosis of tumour cells occurred in all eight malignant tumours encountered in this series.The outstanding feature was the specific destruction of tumour tissue by a bodily process without participation of any outside agent. Emphasis was placed on an adequate inflammatory response following temporary anoxia, although a precise definition of this inflammation could not be offered. Post-ligation bacterial multiplication, which may be expected to occur in necrotic tumour tissue, is considered to be a secondary effect rather than a possible primary cause of regression and disappearance of the tumour.If ligation treatment can be shown to be successful for a particular type of tumour, it may be possible to apply it to human patients for the treatment of areas not amenable to surgery.The results reported here warrant new experimental approaches to the study of neoplasms at the cellular level to define more precisely the anoxic and inflammatory processes involved in the selective lethal effect on tumour tissues; and the authors suggest that trials should be undertaken of combinations of chemotherapy or irradiation with ligation to reduce ligation time and extend the possible benefits.

Animals↗
PubMed2003

Bilateral ascending uterine artery ligation vs. tourniquet use for hemostasis in cesarean myomectomy. A comparison.

OBJECTIVE: To comparatively investigate the effects of using bilateral ascending uterine artery ligation and tourniquet use on intraoperative and postoperative blood loss during myomectomy in cesarean cases. STUDY DESIGN: A total of 70 pregnant women diagnosed with myomas in the prenatal period were included in this randomized, prospective study. They were admitted to our department during the study period. Fifty-two patients who underwent cesarean myomectomy were randomly divided into 2 equal groups. In the first group bilateral ascending uterine artery ligation and myomectomy were performed after lower uterine segment transverse cesarean section. The second group served as the control group; myomectomy was performed with a tourniquet. For statistical analysis, Mann Whitney U, chi 2 and Wilcoxon Rank tests were used. Spearman correlation analysis (rs, n, p) was used for analysis of correlation between the duration of the myomectomy operation and blood loss and number of enucleated myoma nuclei during myomectomy. RESULTS: Total intraoperative blood loss, total operation duration, number of enucleated myoma nuclei (Mann Whitney U test) and febrile morbidity (chi 2 test) were similar in the 2 groups (P > .05). A significant positive correlation was established between the duration of the myomectomy operation and loss of blood and number of enucleated myoma nuclei during myomectomy (rs = .9, n = 52, P = .000). Urgent laparotomy and bilateral internal iliac artery ligation had to be performed in 1 patient in the tourniquet group who had a postoperative hemorrhage. CONCLUSION: Despite the fact that bilateral ascending uterine artery ligation and tourniquet use had similar outcomes with regard to intraoperative blood loss in cesarean myomectomy cases, the efficacy of ligation on blood loss in the postoperative period continues owing to its permanence. The tourniquet method is not effective in the postoperative period since the tourniquet is removed at the end of the operation. Therefore, bilateral ascending uterine artery ligation may be preferable in cesarean myomectomy cases.

Adult↗
PubMed1992

Increased Na(+)-dependent D-glucose transport and altered lipid composition in renal cortical brush-border membrane vesicles from bile duct-ligated rats.

Erythrocyte membranes of patients with liver disease are characteristically enriched in cholesterol, a change known to impair several carrier-mediated membrane transport functions. In the present study we have assessed whether experimental liver disease can affect the membrane lipid composition and transport function of kidney epithelial cells. Small (about 5%) but significant (P less than 0.01) increases were found in the cholesterol-to-phospholipid molar ratio (C/PL) of rat renal cortical brush-border membrane (BBM) vesicles 3, 8, and 15 days after bile duct ligation which correlated closely with increased fluorescence polarization, i.e., decreased membrane fluidity (r = 0.75, P less than 0.001; n = 27). A lipoprotein-mediated pathogenesis was suggested by the close relationship between BBM C/PL and plasma C/PL (r = 0.69, P less than 0.001). The mean high-affinity Na(+)-coupled D-glucose uptake by BBM vesicles was higher 1, 3, 8, and 15 days after ligation than in non-operated rats, significantly so at 3 and 8 days (611 +/- 37 and 593 +/- 22 vs. 507 +/- 21 pmol/mg protein per 4 sec; P less than 0.05), and was positively correlated with BBM C/PL (r = 0.58, P less than 0.01) and fluorescence polarization (r = 0.41, P less than 0.05). Brief incubation of BBM vesicles from normal rats with cholesterol-rich phospholipid liposomes simultaneously increased BBM C/PL and Na(+)-dependent D-glucose uptake. Stimulation of BBM Na(+)-glucose cotransport in ligated rats was not due to delayed dissipation of the Na+ gradient or to a more rapid development of membrane potential. High-affinity Na(+)-dependent D-glucose uptake kinetics in 3-day bile duct-ligated rats showed a lower Kt, without an alteration in maximum velocity, Vmax, compared to sham-operated animals (0.298 +/- 0.015 vs. 0.382 +/- 0.029 mM; P less than 0.05), whilst the binding dissociation constant, Kd of high-affinity phlorizin binding sites was reduced by ligation (0.453 +/- 0.013 vs. 0.560 +/- 0.015 microM; P less than 0.001). We conclude that an early effect of bile duct ligation is to enrich renal cortical brush-border membranes in cholesterol, thereby decreasing membrane fluidity and stimulating Na(+)-dependent D-glucose uptake by increasing the affinity of the carrier.

Animals↗
PubMed1988

Hepatic artery ligation or embolization and locoregional chemotherapy of liver metastases from colorectal cancer.

If liver metastases are diffuse and spread out in the two lobes of the liver, the question remains as to which treatment should be given. Experimental studies showed that when a tumor grows, its vascular pattern becomes mainly arterial. However, if the tumor is still increasing, its center becomes progressively necrotic. After hepatic artery ligation the blood flow of the liver metastases decreases by 90% in the tumor but depriving the arterial circulation of the tumor is not sufficient to achieve a complete cure since the portal blood supply always saves a rim of neoplastic cells around the necrotic area. On the other hand, local infusion of chemotherapy for liver metastases by the arterial route showed a response rate varying between 34 and 70% and the median survival varying between 8 and 17 months. When FUdR chemotherapy was administered using a totally implantable drug infusion pump no improvement in the survival was observed and moreover a high level of toxicity was described including hepatitis and biliary sclerosis. A combined therapy seems a rational approach to treat tumor cells in surviving to the arterial ligation by perfusing the liver with cytotoxic drugs via the portal vein. Taylor's study was very promising but a randomized phase III clinical trial led by the gastrointestinal cancer group of the EORTC with the aim to evaluate the effectiveness of hepatic artery ligation and portal infusion of 5-FU did not show any difference in the survival of the treated patients when compared with patients treated by hepatic artery ligation alone. 77 patients were registered. Data are now available for 55 patients, respectively 30 and 25 patients in the treated group and in the control group. In both groups the median time to progression was 6 months and the median survival time was 12 months. 20% of the patients treated by hepatic artery ligation and portal chemotherapy had a response, one of them with a complete response, 5 with partial response and 14 patients without significant change in the size of their metastases. On the contrary, in the group treated by hepatic artery ligation alone, only one patient had a partial response with 13 patients having no change in the size of their metastases.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

The effect of short-term and long-term femoral artery ligation on rat calf muscle oxygen tension, blood flow, metabolism and function.

The effect of short-term (1 day-1 week) and long-term (6-12 weeks) femoral artery ligation on the oxygen tension (pO2), blood flow, metabolism and function of rat gastrocnemius muscle has been examined. Femoral artery ligation reduced resting blood flow, pO2 and pH. Concomitantly, the concentration of high energy phosphates was reduced and the muscle lactate concentration increased. The fatigue developed by the gastrocnemius/plantaris muscle, during a 10 min period of isometric exercise, was increased and the associated hyperaemia was attenuated. The surgery, performed to ligate the artery, induced an increase in the plasma fibrinogen concentration and whole blood viscosity. As the time interval increased after the femoral artery ligation there was a progressive reduction of the magnitude of the effects. Ten weeks after ligation resting muscle concentrations of high energy phosphates and lactate, whole blood viscosity and muscle pH had normalized. However, resting muscle blood flow, pO2, ability to sustained isometric exercise and the exercise induced hyperaemia were still reduced compared to intact animals. Comparison with literature data reveals that the changes produced by chronic femoral artery ligation in rat calf muscle mimic those seen in man with intermittent claudication.

Animals↗
PubMed1988

The effect of hepatic artery ligation for irresectable cavernous hemangioma of the liver.

During the past 19 years, 52 cases of hepatic cavernous hemangioma have been treated at our institution. Thirty patients underwent hepatic resection. In six patients, the extensive tumor mass invaded multiple segments or both lobes of the liver and complete resection was deemed hazardous. Therefore, hepatic artery ligation was carried out. In all six cases the hemangioma occupied more than two segments. Right hepatic artery ligation was done in five patients and left hepatic artery ligation in one. All are doing well without complication. The longest follow-up is 19 years and the shortest 2 years and 2 months following operation. Four patients have been followed for more than 4 years and in all patients there are no residual complaints. Computerized tomography (CT) revealed the reduction of the tumor size after arterial ligation. One patient suffered from cholecystolithiasis 9 years after hepatic artery ligation, and at the time of cholecystectomy, a biopsy and microscopic examination of the lesion revealed evidence of fibrotic degeneration of the hemangioma. These findings indicate the effectiveness of hepatic artery ligation for treatment of hepatic cavernous hemangioma that are judged hazardous to resect.

Adult↗
PubMed1986

[Rubber-band ligation of hemorrhoids].

In the last few years there has been a considerable reduction in surgical treatment of piles; on the other hand a series of therapeutic outpatient treatments has developed aiming at a conservative management of piles. This new approach is mainly due to high costs in surgical treatment. In accordance also with the experience of the most important proctologic centres, nowadays only 26% of our patients suffering from piles undergo operation, since we regard rubber band ligation as a more rational and economical method for the treatment of hemorrhoids. The instruments and the technique related to band ligation have been described together with some modifications suggested by our personal experience. Indications and contraindications for rubber band ligation have been analyzed pointing out that, in our opinion, such an approach is advised also in the management of stage 3 and 4 hemorrhoids; on the other hand the surgical treatment has its role when band ligation is contraindicated. We have then reported about the good results obtained with 162 patients suffering from stage 2, 3 and 4 hemorrhoids, by using band ligation. Our experience, in accordance with international literature, enables us to emphasize the almost complete absence of complications and the satisfactory results of band ligation, even if compared to other methods.

Hemorrhoids↗
PubMedDate not supplied

Ligation of the renal vein during resection of abdominal aortic aneurysm.

In resection of abdominal aortic aneurysm, ligation and division of the left renal vein may be necessary in order to expose the perirenal aorta. This manoeuvre is possible, with conservation of the left kidney function, because of the extensive venous collateral circulation of the left kidney. It is of crucial importance however, that ligation of the vein is performed close to the inferior vena cava. A case is presented where ligation of the left renal vein was performed in relation to an operation for a ruptured abdominal aortic aneurysm. After the operation there was initially dysfunction of the left kidney, and later on sepsis-induced uraemia. The renal function stabilized at a moderately reduced level. No permanent kidney damage related to the venous ligation could be demonstrated. In the literature serious renal damage has been reported in 10 cases out of 89 reported ligations of the left renal vein. Ligation of the left renal vein is thus a reasonably safe and acceptable procedure for surgical exposure in difficult aortic procedures.

Aorta, Abdominal↗
PubMed1986

Venous injury: to repair or ligate, the dilemma.

Surgical management of major venous injuries remains controversial. The medical records of 184 patients with major venous injury were reviewed. Forty-three patients had isolated venous injury; 31 of 43 patients (72%) underwent ligation to treat their vein injury. Another 141 patients had combined arterial and venous injury; 117 of these patients (83%) had ligation. Injured were the inferior vena cava, iliac, femoral, popliteal, distal leg, and arm veins; all patients underwent surgical exploration. Arterial injuries were repaired by standard techniques and venous injuries were either ligated or repaired by end-to-end or lateral phleborrhaphy. Adjunctive fasciotomy was used when clinically indicated. The patients were followed up for 1 month to 9 years. No permanent sequelae of venous ligation were identified. Transient extremity edema developed in up to 32% of patients, regardless of whether vein ligation or repair was performed. This edema resolved completely within 12 weeks of the injury. No extremity was lost after ligation of a venous injury. Although it may be ideal to repair all venous vascular injuries, selective management reflecting mechanism of injury, blood loss, anesthesia requirements, associated organ injury, and other concerns may mitigate against extensive venous repair.

Adolescent↗
PubMed1981

Comparison of rubber band ligation and sclerosant injection for first and second degree haemorrhoids-- a prospective clinical trial.

Fifty patients with first or mild second degree haemorrhoids were randomly allocated to sclerosant injection (26) or rubber band ligation (24). One year after treatment 24 injection and 22 rubber band ligation patients were assessed. All patients presented with rectal bleeding; injection relieved 14 and rubber band ligation relieved 17 of this symptom (N.S.). Three of seven patients with prolapsing haemorrhoids who had sclerosant injections and five of seven who had rubber band ligation were relieved of this prolapse. However, a further six patients in the injection group developed prolapse for the first time during the one year follow-up period (p less than 0.05). Rubber band ligation relieved anal pain in 10 out of 14 patients whereas injection relieved only one patient of this symptom (p less than 0.05). Neither treatment influenced pruritus ani or faecal soiling. Although rubber band ligation caused more treatment discomfort, it is an effective management for first and mild second degree haemorrhoids and it should be considered as the procedure of choice.

Adult↗
PubMed1994

Management of hemorrhoids by rubber band ligation.

This study discusses the management of hemorrhoids by rubber band ligation. It reviews 233 rubber band ligation procedures in 148 patients with symptomatic hemorrhoids performed over a 5-year period. 72% of the patients underwent a single rubber band ligation, 22% a double band ligation and 6% a triple band ligation in one session without anesthesia. A follow-up of 18 +/- 5 months was carried out. Only three patients required hospitalization for complications. One patient was admitted for bleeding and recovered with clot evacuation, bed rest and blood transfusion. Two patients developed a band related abscess that resolved with drainage. Twenty patients (13.5%) reported pain associated with the procedure. Four patients needed subsequent surgical hemorrhoidectomy. Long-term results were good in 81.2% of the patients. This report agrees with previously published series showing the efficacy and cost containment of hemorrhoidal ligation.

Adult↗
PubMed1994

Evaluation of mesenteric lymphangiography and thoracic duct ligation in cats with chylothorax: 19 cases (1987-1992).

Mesenteric lymphangiography and thoracic duct ligation were performed on 19 cats with chylothorax between 1987 to 1992. Chylothorax was diagnosed on the basis of detection of chylomicrons in the pleural effusion or determination of a cholesterol concentration:triglyceride concentration ratio of < 1 in the pleural fluid. Preoperative medical treatment consisted of thoracentesis (19 of 19 cats) and feeding a fat-restricted diet (14 of 19 cats). Positive-contrast mesenteric lymphangiography was performed before thoracic duct ligation to identify an underlying cause for the effusion. Lymphangiectasia was diagnosed by use of radiography in 17 cats, none of which had evidence of a thoracic duct rupture. Thoracic duct ligation was performed via an incision made through the left 10th intercostal space. Lymphangiography was repeated immediately after ligation of the thoracic duct to document occlusion of all branches. Follow-up monitoring was done for 12 to 47 months (median, 28 months) and consisted of physical examination, evaluation for clinical signs related to pleural effusion, and thoracic radiography. Ten of 19 (53%) cats had complete resolution of pleural effusion. Nonchylous effusion, localized in the right hemithorax, was detected in 1 cat 2 months after thoracic duct ligation, but resolved after thoracotomy, breakdown of thoracic adhesions, and expansion of the right cranial lung lobe. Chylous effusion resolved 3 to 7 days (mean, 5.4 days) after surgery in the 10 cats that survived > 12 months after surgery. Four cats died between 2 and 13 days after thoracic duct ligation, but pleural effusion had resolved in 3 of these 4 cats at the time of death.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

[Sclerotherapy versus ligation in hemorrhage caused by rupture of esophageal varices. Direct meta-analysis of randomized trials].

OBJECTIVES: To compare the advantages of endoscopic ligation and endoscopic sclerotherapy for bleeding esophageal varices, published randomized clinical trials were critically reviewed by meta-analysis. Only ten clinical trials concerning a history of recent or active bleeding esophageal varices were included. METHODS: The methodology, population, treatment and outcomes of each relevant trial were evaluated by duplicate independent review. RESULTS: Endoscopic sclerotherapy compared to banding ligation significantly increased the rate of rebleeding (OR: 1.6; 95% IC: 1.1-2.3) without increasing early mortality compared to endoscopic banding ligation (OR: 1.3; 95% IC: 0.8-1.9). The rate of varice eradication associated with these two types of treatment was not different (OR: 0.9; 95% IC: 0.6-1.3) but was obtained more quickly with endoscopic banding ligation (3.8 +/- 1.6 versus 5.8 +/- 2.2; P < 0.05). The rate of complications was higher after sclerotherapy (OR: 2.5; 95% IC: 1.7-3.7), in those cases with a positive heterogeneity test. CONCLUSIONS: This meta-analysis shows a lower morbidity with endoscopic banding ligation in patients with variceal hemorrhage. The most important advantage of endoscopic banding ligation was the reduction of the rate of rebleeding.

Endoscopy↗
PubMed1997

Sequential changes of esophageal motility after endoscopic injection sclerotherapy or variceal ligation for esophageal variceal bleeding: a scintigraphic study.

OBJECTIVE: Endoscopic injection sclerotherapy and variceal ligation are two popular endoscopic methods used to treat esophageal variceal hemorrhage. These two methods have not been compared with regard to esophageal dysfunction after treatment. This is a prospective investigation of esophageal dysmotility after endoscopic injection sclerotherapy and variceal ligation. METHODS: Sequential changes of esophageal motility after endoscopic injection sclerotherapy (n = 25) and variceal ligation (n = 25) were investigated in 50 cirrhotic patients with recent variceal bleeding. Another 22 cirrhotics without esophageal varices were included as controls. Radionuclide esophageal transit tests were performed before initial endoscopic treatment, and 1 and 3 months after variceal eradication. RESULTS: The baseline esophageal transit time was longer in both the sclerotherapy (n = 25, 7.8 +/- 1.4 s) and ligation groups (n = 25, 8.2 +/- 1.8 s) than in controls (n = 22, 6.7 +/- 0.7 s, p < 0.005). The transit time was longer in patients with large varices than in those with small varices (8.3 +/- 1.7 vs. 7.2 +/- 0.7 s, p < 0.05). In the sclerotherapy group, the transit time was prolonged 1 month after variceal eradication, compared with its pretreatment state (n = 20, 7.6 +/- 1.5 vs. 10.0 +/- 2.2 s, p < 0.0001) but was shortened at 3 months compared with 1 month after variceal eradication (n = 12, 10.7 +/- 1.5 vs. 8.6 +/- 2.2 s, p < 0.05). Multiple regression analysis showed that the number of treatment sessions required to eradicate varices was the only significant factor associated with prolonged transit time (p < 0.05). In the ligation group, the transit time changed little at 1 month or 3 months after variceal eradication. CONCLUSIONS: Impairment of esophageal motility can be significant with endoscopic injection sclerotherapy but is reversible. However, endoscopic variceal ligation exerts no significant impact on esophageal motility.

Esophageal and Gastric Varices↗