No abstract

PURPOSE: Variceal bleeding remains a life-threatening emergency. Gastric fundal varices (GV) are responsible for up to 10-15% of all variceal bleeding. Endoscopic obliterative therapy with Histoacryl is now the first-choice treatment for control of gastric variceal bleeding. Pulmonary complications after injection sclerotherapy are common and range from minor asymptomatic changes to adult respiratory distress syndrome. Based on this; we tried to assess the pulmonary changes associated with endoscopic injection sclerotherapy of gastric fundic varices using undiluted N-Butyl-Cyanoacrylate METHODS: Out of 90 patients who were admitted to Tropical Medicine Department, Mansoura University Hospitals only fourty patients were inrolled in this study. Patients were grouped into; group I including 20 patients with gastric fundic varices with previous history of hematemesis and/or melena and treated with injection sclerotherapy by using undiluted N-Butyl Cyanoacrylate (NBCA) and group II including 20 patients underwent diagnostic upper GIT endoscopy for detection of varices. Patients were subjected to pulmonary function tests including Diffusion of Lung using Carbon monoxide (DLCO) the day before and one week after endoscopic procedure RESULTS: The results revealed significant decrease in Forced Expiratory Volume 1 (FEV1) and Forced Vital Capacity (FVC) p# 0.05 and Diffusion of Lung using Carbon monoxide DLCO p # 0.05 while no significant change in ratio between FEV1/FVC % (p¼0.16) in group I after procedure. There was no significant decrease in FEV1 and FVC (p¼0.3) and DLCO was constant and no significant change in ratio between FEV1/FVC % (p¼0.3) in group II after endoscopy. Four patients in group I developed mild pleural effusion and only one patient developed atelectitic band after procedure while no significant difference in chest X ray and CT chest in patients in group II after endoscopy. There was significant negative correlation between age of the patient, Child score and number of NBCA ampoules injected and different respiratory function test parameters in group I after endoscopic procedure. CONCLUSIONS: After injection of gastric fundic varices using undiluted NBCA, there was a fall in FEV1 and FVC without any change in FEV1/ FVC ratio suggesting a restrictive pattern of pulmonary function test and significant fall in DLCO suggesting diffusion defect and about 20% of patients developed mild right sided pleural effusion and about 5% of patients developed atelectitic band.