Effect of Variceal Eradication on Portal Circulation
Effect of Variceal Eradication on Portal Circulation
Study the effect of variceal eradication on portal circulation, liver stiffness and
 Child-Pugh and MELD scores in patients with liver cirrhosis.
Portosystemic collateral circulation is a consequence of portal hypertension, which occurs in
 chronic liver disease and is responsible for numerous complications.

 Gastric and oesophageal varices are two of common portosystemic collaterals, patients usually
 presented with hematemesis, melena, or both, ultimately 20% is the mortality during the first
 attack.

 Although both band ligation and sclerotherapy are effective modalities of treatment in
 controlling acute variceal bleeding, in preventing future variceal bleeding as well as in
 eradicating varices with very few complications , their effects on portal circulation have
 raised concerns among hepatologist.

 Information about collateral pathways is especially relevant when interventional procedures
 or surgery is indicated because inadvertent distribution of these vessels can cause
 significant bleeding.

 Few studies pointed on development of new portosystemic collaterals post variceal eradication
 depending on abdominal computed tomography (CT ) compared to pre-variceal eradication as
 showed paraoesophageal varices, retro-gastric varices not visualized with endoscopy ,or large
 deep gastric collaterals that may increase risk for rebleeding.

 Also, liver stiffness measurement and indirect markers of portal hypertension have been
 correlated with the severity of portal hypertension and have been used to predict the
 presence of varices, and there is rising question what about effect of variceal eradication
 on liver stiffness.

 The Child-Pugh and MELD scores were significantly higher for patients with gastric variceal
 bleeding , and the question here is variceal eradication can improve Child-Pugh and MELD
 scores or there is no effect.
Inclusion Criteria:

 -  • Age between 18 and 70 years old.

 -  Patient with documented liver cirrhosis undergoing either primary or secondary
 prophylactic variceal eradication.

 -  Liver cirrhosis with Child-Pugh score A and B.

 Exclusion Criteria:

 -  • Age less than 18 years.

 -  Have contraindications to computed abdominal CT-angiography (e.g. allergy to all
 suitable contrast agents, renal failure).

 -  Patients with history of recent significant bleeding varices.

 -  Previous history of variceal ligation, sclerotherapy, and TIPS operation.

 -  Patients with isolated gastric varices.

 -  Patients with HCC or other malignancies.

 -  End-stage liver disease (Child score more than 9).

 -  Patients with malignant portal vein thrombosis.

 -  Patients with non-cirrhotic portal hypertension.

 -  Patients refuse to participate in the study.