Endoscopic Variceal Sequential Ligation Does Not Increase Risk of Gastroesophageal Reflux Disease in Cirrhosis Patients
Endoscopic Variceal Sequential Ligation Does Not Increase Risk of Gastroesophageal Reflux Disease in Cirrhosis Patients
复制标题
内镜下静脉曲张序贯结扎不会增加肝硬化患者胃食管反流病的风险
DOI：
10.1007/s10620-019-05740-1
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发表时间：
2020-01-01
影响因子：
3.1
通讯作者：
Wu, Bin
中科院分区：
文献类型：
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作者：
Tao, Jin;Li, JianZhong;Wu, Bin
背景内镜下食管静脉曲张序贯结扎术（EVSL）是预防食管静脉曲张再出血和实现充分止血的首选内镜治疗方法。目前缺乏共识，围绕EVSL引起的食管运动功能和异常reflux.AimsTo探讨食管运动功能的改变和异常胃食管反流的风险，在肝硬化患者食管静脉曲张，EVSL. MethodsTwenty-One肝硬化食管静脉曲张患者进行了研究，采用测压和24小时pH值监测1天前和1个月后EVSL。结果EVSL后食管近端（P> 0.05）和远端（P> 0.05）蠕动收缩波的振幅、持续时间和异常食管收缩波形的百分比均无明显变化。EVSL后食管下括约肌压力明显降低（16.1 ± 7.9mmHg vs21.1 ± 6.3mmHg，P< 0.05）。EVSL后患者的各种定量参数，包括pH < 4.0的总监测时间百分比、反流发作总数、反流发作> 5 min的次数和DeMeester评分均未增加。异常反流监测24小时pH值监测发生在10（47.6%）pre-EVSL患者和11（52.4%）post-EVSL patients.ConclusionsAlthough EVSL影响食管动力相对降低LES压力，它不会引起大量的运动异常，也不会增加肝硬化患者异常胃食管反流病的风险。
BackgroundEndoscopic variceal sequential ligation (EVSL) is currently endorsed in our hospital, as the preferred endoscopic treatment for prevention of variceal rebleeding and achieving adequate hemostasis. There is currently a lack of consensus surrounding EVSL-induced changes in esophageal motor function and abnormal reflux.AimsTo explore alterations in esophageal motor function and risk of abnormal gastroesophageal reflux in liver cirrhosis patients with esophageal varices, after EVSL.MethodsTwenty-one liver cirrhosis patients with esophageal varices were studied using manometry and 24-h pH monitoring 1 day prior to and 1 month following EVSL. The EVSL consisted of performing esophageal variceal ligation using a multi-band ligator, which was repeated every 4 weeks until the varices were eradicated.ResultsThe amplitude and duration of peristaltic contraction waves and the percentage of abnormal esophageal contraction waveforms were unaltered in both the proximal (P> 0.05) and the distal (P> 0.05) esophagus after EVSL. However, the lower esophageal sphincter pressure was decreased following EVSL (16.1 ± 7.9 mmHgvs21.1 ± 6.3 mmHg (P< 0.05)). Various quantitative parameters including percentage of total monitoring time with pH < 4.0, total number of reflux episodes, number of reflux episodes > 5 min, and DeMeester scores were not increased in post-EVSL patients. Abnormal reflux monitored by 24-h pH monitoring occurred in ten (47.6%) pre-EVSL patients and 11 (52.4%) post-EVSL patients.ConclusionsAlthough EVSL affects esophageal motility by relatively decreasing LES pressure, it does not induce substantial motor abnormalities nor increase risk of abnormal gastroesophageal reflux disease in cirrhosis patients.