Changes in Esophageal Variceal Pressure after Transcatheter Arterial Embolization for Hepatocellular Carcinoma

Background and Study Aim: The aim of this study was to investigate the influence of transcatheter arterial embolization on esophageal variceal pressure and portal hemodynamics.

Patients and Methods: Out of 18 cirrhotic patients with hepatocellular carcinoma, 12 underwent transcatheter arterial embolization and the remaining six patients underwent angiography alone as a control. We examined esophageal variceal pressure with an endoscopic pneumatic pressure sensor and portal blood flow with Doppler ultrasonography immediately before and 3 days after transcatheter arterial embolization or angiography.

Results: Angiography alone did not influence esophageal variceal pressure or portal blood flow. Transcatheter arterial embolization resulted in an increase in variceal pressure in five (42%) of the 12 patients and in a marked increase in portal blood flow in eight (88.9%) of nine patients, although no change in the endoscopic variceal findings was observed after transcatheter arterial embolization. The change in esophageal variceal pressure did not correlate with the change in portal blood flow. We could not find predictive factors for the elevation of variceal pressure after transcatheter arterial embolization.

Conclusion: Our study demonstrated that transcatheter arterial embolization resulted in an increase in esophageal variceal pressure in about half of the patients, bearing little relation to portal hemodynamic parameters.

References

• 1 Chuang V P, Wallace S. Hepatic artery embolization in the treatment of hepatic neoplasms.  Radiology. 1981;  140 51-58
• 2 Yamada R, Sato M, Kawabata M, et al. Hepatic artery embolization in 120 patients with unresectable hepatoma.  Radiology. 1983;  148 397-401
• 3 Bismuth H, Morino M, Sherlock D, et al. Primary treatment of hepatocellular carcinoma by arterial chemoembolization.  Am J Surg. 1992;  163 387-394
• 4 Lin D Y, Wu C S, Chen P C. Gastrointestinal bleeding after hepatic transcatheter arterial embolization in patients with hepatocellular carcinoma.  Gastrointest Endosc. 1996;  43 132-137
• 5 Takayasu K, Moriyama N, Muramatsu Y, et al. Gallbladder infection after hepatic artery embolization.  Am J Roentgenol. 1985;  144 135-138
• 6 Kishimoto W, Nakao A, Takagi H, Hayakawa T. Acute pancreatitis after transcatheter hepatic arterial embolization (TAE) for hepatocellular carcinoma.  Am J Gastroenterol. 1989;  84 1396-1399
• 7 Okuda K. The Liver Cancer Study Group of Japan. Primary liver cancers in Japan.  Cancer. 1980;  45 2663-2669
• 8 Mosimann R. Nonaggressive assessment of portal hypertension using endoscopic measurement of variceal pressure.  Am J Surg. 1982;  143 212-214
• 9 Bosch J, Bordas J M, Rigau J, et al.. Noninvasive measurement of the pressure of esophageal varices using an endoscopic gauge:comparison with measurements by variceal puncture in patients undergoing endoscopic sclerotherapy.  Hepatology. 1986;  6 667-672
• 10 Bandoh T, Mitarai Y, Kitano S, et al.. Clinical significance of esophageal variceal pressure in patients with esophageal varices.  J Hepatol. 1994;  21 326-331
• 11 Rigau J, Bosch J, Bordas J M, et al. Endoscopic measurement of variceal pressure in cirrhosis: correlation with portal pressure and variceal hemorrhage.  Gastroenterology. 1989;  96 873-880
• 12 Nevens F, Bustami R, Scheys I, et al. Variceal pressure is factor predicting the risk of a first variceal bleeding: a prospective cohort study in cirrhosis patients.  Hepatology. 1998;  27 15-19
• 13 Toba N. Esophageal variceal pressure by endoscopic pneumatic pressure sensor in patients with liver cirrhosis (in Japanese).  Jpn J Gastroenterol. 1989;  86 214-219
• 14 Okada K. The relation of portohepatic hemodynamics and clinical usefulness of endoscopic variceal pressure measurement (in Japanese).  J Yonago Med Ass. 1998;  49 95-106
• 15 Koda M, Murawaki Y, Kawasaki H, Ikawa S. Portal blood velocity and portal blood flow in patients with chronic viral hepatitis: relation to histological liver fibrosis.  Hepato-Gastroenterology. 1996;  43 199-202
• 16 Japanese Research Society for Portal Hypertension . The general rules for recording endosocopic findings on esophageal varices.  Jpn J Surg. 1980;  10 84-87
• 17 Moriyasu F, Ban N, Nishida O, et al. Portal hemodynamics in patients with hepatocellular carcinoma.  Radiology. 1986;  161 707-711
• 18 Taourel P, Dauzat M, Lafortune M, et al. Hemodynamic changes after transcatheter arterial embolization of hepatocellular carcinoma.  Radiology. 1994;  191 189-192
• 19 Lautt W W, Greenway C V. Conceptual review of the hepatic vascular bed.  Hepatology. 1987;  7 952-963
• 20 Aoki H, Hasumi A, Shimizu M. The hemodynamics of esophago-gastric varices: Significance of esophago-gastric arterial inflow in their formation. In: Idezuki Y (ed). Treatment of esophageal varices.  Amsterdam; Elsevier Science 1988: 315-328
• 21 Ngan H, Pch W CG. Arteriovenous shunting in hepatocellular carcinoma: its prevalence and clinical significance.  Clin Radiol. 1997;  52 36-40