Predictive Factors and Outcome of Esophageal Ulcers After Endoscopic Treatment of Esophageal Varices
Predictive Factors and Outcome of Esophageal Ulcers After Endoscopic Treatment of Esophageal Varices
Aim of this thesis is to predict the incidence of esophageal ulcer bleeding after endoscopic
 management of esophageal varices.

 This study will be in the department of Tropical Medicine and Infectious Diseases, Tanta
 University, in at least six months in the period from august 2014 to march 2015 or until the
 target number of patients reached whichever is longer.
Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the
 portal venous pressure, in which the hepatic venous pressure gradient (HVPG) is increased
 above normal values (1-5 mmHg). In cirrhosis, portal hypertension results from the
 combination of increased intrahepatic vascular resistance and increased blood flow through
 the portal venous system.

 Esophageal variceal bleeding is one of the most serious complications of portal hypertension,
 and represents a leading cause of death in patients with cirrhosis. Each bleeding episode is
 associated with a 30% mortality rate.

 Endoscopic therapies for varices aim to reduce variceal wall tension by obliteration of the
 varix. The two principal methods available for esophageal varices are endoscopic
 sclerotherapy (EST) and band ligation (EBL). Endoscopic therapy is a local treatment that has
 no effect on the pathophysiological mechanisms that lead to portal hypertension and variceal
 rupture. However, a spontaneous decrease in HVPG occurs in around 30% of patients treated
 with either EST or EBL to prevent variceal rebleeding. EST consists of the injection of a
 sclerosing agent into the variceal lumen or adjacent to the varix, with flexible catheter
 with a needle tip, inducing thrombosis of the vessel and inflammation of the surrounding
 tissues. During active bleeding, sclerotherapy may achieve hemostasis, inducing variceal
 thrombosis and external compression by tissue edema. With repeated sessions, the inflammation
 of the vascular wall and surrounding tissues leads to fibrosis, resulting in variceal
 obliteration.

 Furthermore, vascular thrombosis may induce ulcers that also heal, inducing fibrosis. There
 are technical variations in performing EST, such as type and concentration of the
 sclerosants, volume injected, interval between sessions, and number of sessions Endoscopic
 band ligation (EBL) is generally accepted as the treatment of choice for bleeding from
 esophageal varices. It has shown good results in terms of the control of the active bleeding,
 with few untoward effects.

 Esophageal ulcerations ulcerations occur in the esophageal mucosa after all successful
 ligations. However, ulcers following Esophageal Variceal Ligation (EVL) are less severe than
 with ES.

 Aim of this thesis is to predict the incidence of esophageal ulcer bleeding after endoscopic
 management of esophageal varices.

 . This study will be in the department of Tropical Medicine and Infectious Diseases, Tanta
 University, in at least six months in the period from august 2014 to march 2015 or until the
 target number of patients reached whichever is longer.

 The study include more than 224 patients who undergo endoscopic management of esophageal
 varices:

 Methods:

 All patients will be subjected to:

 -  full history taking.

 -  -complete clinical examination.

 -  -investigations for all groups: i) Complete Blood Count (CBC) ii) liver function tests
 iii) Kidney function tests. iv) ultrasound on abdomen and pelvis

 -  Upper endoscopy at day 0 , follow up endoscopy at day 14 and at 6months

 End points:

 1. ry end point:at 14 days to look for and characterize ulcer if any

 2. ry end point: at 6months to look for general and local outcome of intervention

 Inclusion criteria:

 Patient with esophageal varices having upper GIT endoscopy

 Exclusion criteria:

 Patients having endoscopy with no esophageal varices (EVs)

 ETHICAL CONSIDERATIONS Unexpected risks during the course of the research will be cleared to
 the participants and the ethical committee on time , thrombophlebitis may occur during taking
 blood sample, the investigators will use sterilized techniques during taking sample also
 bleeding from pinpoint needle track could happen , the investigators will do needle track
 ablation to avoid it. The investigators will use sterilized techniques during taking sample.

 Informed consent will be taken and everyone will be given a coded number . Names will not be
 mentioned ,no pictures will be taken to any part of the body. Results of investigations will
 be collected, tabulated and statistically analyzed for scientific purposes only.
Inclusion Criteria:

 -  Patient with esophageal varices having upper GIT endoscopy

 Exclusion Criteria:

 -  Patients having endoscopy with no EVs