Effects of endoscopic variceal ligation on systemic and splanchnic hemodynamics in patients with cirrhosis

It has been shown that patients with cirrhosis and portal hypertension have hyperdynamic systemic and splanchnic circulation. This study was designed to assess how endoscopic variceal ligation may influence systemic and splanchnic hemodynamics. Sixteen patients with cirrhosis and esophageal varices were studied. Cardiac output and flow volume of the portal vein and the superior mesenteric artery were determined by means of duplex Doppler ultrasonography. Mean arterial pressure was also recorded. These hemodynamic measurements were performed before and after initial (3 days after initial session) and repeated (7 days after last session) variceal ligation. No significant changes in cardiac output and mean arterial pressure were found after either initial or repeated variceal ligation. Thus, systemic vascular resistance was not modified. In splanchnic hemodynamics, portal vein blood flow significantly increased after initial variceal ligation (27%, P < 0.01) but it returned to the baseline value after repeated variceal ligation. In contrast, superior mesenteric artery blood flow significantly decreased after initial variceal ligation (17%, P < 0.01) and it returned to the baseline value after repeated variceal ligation. Effect of variceal ligation on splanchnic hemodynamics is transient and variceal ligation has very little effect on systemic circulation. Thus, patients with cirrhosis underwent repeated variceal ligation still have abnormal systemic and splanchnic circulation.