Ghoshal U C, Dhar K, Chaudhuri S, Pal B B, Pal A K, Banerjee P K
Department of Gastroenterology, Seth Sukhlal Karnani Memorial Hospital and Institute of Postgraduate Medical Education and Research, 244, Acharya JC Bose Road, Calcutta 700020, India.
Dis Esophagus. 2000;13(2):148-51. doi: 10.1046/j.1442-2050.2000.00104.x.
Endoscopic sclerotherapy (EST) leads to structural and motility changes in the esophagus; the former are thought to be commoner after EST with absolute alcohol (AA), which is a commonly used sclerosant in India as it is cheap and effective. There are no previous studies on changes in esophageal motility after EST with AA. Accordingly, we studied patients with portal hypertension before (n = 24) and after (n = 22) variceal obliteration by EST with AA using a water perfusion esophageal manometry system. Contraction amplitude in the distal esophagus was reduced in the post-EST group compared with the pre-EST group (63.4 +/- 24.9 vs. 18.2 +/- 14.3 mmHg, p < 0.01). Duration of esophageal contraction in both the proximal and distal esophagus became prolonged in the post-EST compared with the pre-EST group (3.3 +/- 0.8 vs. 5.4 +/- 2.6 and 4.3 +/- 1.1 vs. 6.6 +/- 2.3 s, p < 0.001 for both). Lower esophageal sphincter (LES) pressure was reduced in the post-EST compared with the pre-EST group, although the difference was not significant statistically. Abnormal contraction waveforms were more frequent in the post-EST group. One patient in the post-EST group had persistent dysphagia in the absence of endoscopically documented stricture at the time of manometric study. This study shows frequent occurrence of esophageal dysmotility after EST with AA; however, esophageal dysmotility after EST was infrequently associated with motor dysphagia.
内镜下硬化治疗（EST）会导致食管结构和动力改变；人们认为，使用无水乙醇（AA）进行EST后，前者更为常见，AA是印度常用的硬化剂，因其价格便宜且效果良好。此前尚无关于使用AA进行EST后食管动力变化的研究。因此，我们使用水灌注食管测压系统，对24例门静脉高压患者在使用AA进行EST消除静脉曲张之前和22例患者在之后进行了研究。与EST前组相比，EST后组远端食管的收缩幅度降低（63.4±24.9对18.2±14.3 mmHg，p<0.01）。与EST前组相比，EST后近端和远端食管的收缩持续时间均延长（3.3±0.8对5.4±2.6以及4.3±1.1对6.6±2.3秒，两者p均<0.001）。与EST前组相比，EST后组下食管括约肌（LES）压力降低，尽管差异无统计学意义。EST后组异常收缩波形更为常见。在测压研究时，EST后组有1例患者在无内镜记录的狭窄情况下持续存在吞咽困难。本研究表明，使用AA进行EST后食管动力障碍频繁发生；然而，EST后食管动力障碍很少与运动性吞咽困难相关。
