الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Gastrointestinal bleeding driven by portal hypertension represents a common and potentially life threatening complication of chronic liver disease. The most common and most serious site of bleeding is from gastroesophageal varices.
Endoscopic therapy is ’gold’ standard for the treatment of acute variceal hemorrhage. There are currently two forms of endoscopic therapy that are widely used in this setting: - sclerotherapy and band ligation. The aim of the present study is to compare the effects of endoscopic injection sclerotherapy and endoscopic variceal ligation on hepatic and renal functions.
The present study was conducted on 90 patients with esophageal varices due to liver cirrhosis, their age ranged from 18 - 65 years with mean (43.2 ± 9.56). They were 64 male and 26 female. They were admitted to tropical medicine department, Menoufiya University Hospital and classified into: -
- Group I: - 30 patients with esophageal varices whom underwent elective endoscopic injection sclerotherapy (EIS Group).
- Group II: - 30 patients with esophageal varices whom underwent elective endoscopic variceal ligation (EVL Group).
- Group III: - 30 patients with esophageal varices whom underwent diagnostic upper GIT endoscopy (Control Group).
All patients had been subjected to: -
- Full history taking.
- Complete clinical examination.
- Laboratory investigation: urine analysis, stool analysis, complete blood picture, and viral markers (Hepatitis B surface antigen and Hepatitis C antibody).
- Rectal snip to detect bilharziasis.
- Plain X-ray on the chest.
- Abdominal ultrasound.
- Upper GIT endoscopy (EIS, EVL, and Diagnostic endoscopy)
- Liver function tests (ALT, AST, Serum T-Bilrubin, Serum D-Bilrubin, Serum Albumin, and Prothrombin Time).
- Renal Function Tests (Urea and Creatinine).
Liver and renal function tests were done immediately before and 1, 3, 7, and 14 days after each endoscopic procedure.
The Results of the study were tabulated, statistically analyzed, and graphically represented which revealed: -
Significant elevation of Serum T-bilirubin from the value before treatment (Basal value) at 1, 3, and 7 days after sclerotherpy (P<0.01). Significant elevation of Serum D-bilirubin at 3 and 7 days after sclerotherapy (P<0.01). Significant elevation of ALT and AST from Basal value at 1, 3, and 7 days after sclerotherpy (P<0.05). Whereas no significant changes of serum albumin and prothrombin time was observed within 14days after sclerotherapy.
In EVL and control groups study of liver function didn’t show any significant changes within 14 days, as regards ALT, AST, Serum T-bilirubin, Serum D-bilirubin, Serum albumin, and prothrombin time (P>0.05).
Comparison of liver function tests in all groups after endoscopy at the same time point showed significant difference in Serum T-bilirubin and Serum D-bilirubin in the 3rd day (P<0.01) and 7th day (P<0.05) in EIS group from that in EVL and control groups. Also AST and ALT was significantly higher in EIS group than in EVL and control groups in the 3rd day after endoscopy (P<0.01). In contrast there is non-significant difference were observed as regard serum albumin and prothrombin time between studied groups at the same time points within 14 days.
Study of renal functions in each group (EIS, EVL and control groups) did not reveal any significant changes from basal value and within 14 days after endoscopic procedure as regards urea and creatinine (P >0.05).
Study of renal function tests in all groups at the same time point within 14 days after endoscopic procedures didn’t reveal any significant difference as regards urea and creatinine (P>0.05).
Finally, it is concluded that EVL is relatively safe than EIS as regards short-term effects on hepatic and renal functions, but it remains unknown whether, the acute changes induced by EIS influences the long term prognosis of cirrhotic patients with esophageal varices.