Effect of endoscopic variceal sclerotherapy on esophageal motor functions and gastroesophageal reflux.

Abstract

Sclerotherapy results in significant local complications, both immediate and delayed. This study was designed to examine the esophageal pathophysiology underlying these complications. We prospectively evaluated esophageal transit, motility abnormalities and gastroesophageal reflux (GER) with barium studies and esophageal functional scintigraphy in 24 patients (20 men, 4 women; mean age 33 +/- 12.4 yr) before sclerotherapy (Phase I), after two sessions (Phase II), following variceal eradication (Phase III) and 4 wk later (Phase IV). Varices were obliterated after 5.6 +/- 1.9 sessions of intravariceal sclerotherapy performed weekly with 1% polidocanol (17.3 ml per session). There was no baseline Phase I dysmotility or reflux. Phase II studies recorded a marked delay of esophageal global and segmental (mid and distal) transit time in 98.2% of patients by scintigraphy and 90% by barium studies. Incoordinate contractions and aperistalsis were observed in 0, 66.7%, 58.3% and 33.8% of patients from Phases I-IV studies, respectively. Barium studies revealed tertiary waves and reverse peristalsis in 0, 50%, and 75% of patients from Phases I-III; strictures were observed in 0, 1, and 3 patients during Phases I-III. GER was detected scintigraphically in 0, 58.3%, 25% and 16.6% during Phases I-IV sequentially. In contrast, barium studies grossly underestimated GER (0, 5% and 15% at phases I-III). There was strong concordance between esophageal symptoms, transit, motility abnormalities and GER (p < 0.05). Variceal eradication (Phases III and IV) was associated with a gradual recovery of esophageal symptoms, ulcers and all abnormal scintigraphic parameters. Sclerosant-induced chemical esophagitis in association with peptic esophagitis due to gross reflux following sclerotherapy possibly can explain the symptoms in most patients.