Portal venous system after endoscopic sclerotherapy of esophageal varices in patients with liver cirrhosis--prospective study with Doppler sonography

BACKGROUND/AIMS: The aim of this prospective, clinical study was an ultrasonographic color Doppler evaluation of morphological and hemodynamic changes in the portal system prior to and after repeated, endoscopic injection sclerotherapy in patients with liver cirrhosis and hemorrhage from esophageal varices. METHODOLOGY: Twenty-six patients before and after complete eradication of esophageal varices by repeated sclerotherapy with 5% ethanolamine oleate as obliterating agent were examined. The diameter of the portal and splenic veins, the patency of the veins, the direction of the blood flow, the mean and maximal velocity of blood flow, spleen size and presence and number of collateral circulation pathways were determined. Hemodynamic examinations of the portal system were performed with duplex Doppler method with color imaging of blood flow. RESULTS: The study revealed no statistically significant differences between diameters of the portal and the splenic vein or between the size of the spleen prior to and after sclerotherapy. The blood flow was intrahepatic and portal vein thrombosis was not detected in any of the patients. The mean velocity blood flow in the portal vein prior to and after sclerotherapy did not reveal any changes. The maximal velocity of blood flow in the portal vein increased from 23.7 +/- 2.5 cm/s to 27.2 +/- 2.8 cm/s, but it was not statistically significant. Prior to the commencement of sclerotherapy collateral portal-systemic circulation was detected in 17 out of 26 patients (65%), with a total of 25 collateral circulation pathways. After completion of sclerotherapy collaterals were detected in 19 out of 26 patients (73%) and number of pathways was increased by 7. CONCLUSIONS: Endoscopic sclerotherapy of esophageal varices does not affect the direction of blood flow in the portal vein and causes no thrombosis of the portal system. Effective sclerotherapy and complete eradication of esophageal varices results in closure of collateral circulation pathways through submucosal esophageal varices as well as development of new pathways of collateral circulation.