Avaliação da motilidade esofágica após ligadura elástica endoscópica das varizes do esôfago
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2020-02-19
Autores
Moreira, Alecsandro
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Universidade Estadual Paulista (Unesp)
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Avaliação da motilidade esofágica após ligadura elástica endoscópica de varizes de esôfago. 2020. Tese (Doutorado) – Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (Unesp), Botucatu, 2020. A ligadura elástica das varizes esofágicas, por via endoscópica, é o procedimento mais indicado na prevenção primária e secundária da hemorragia digestiva alta varicosa. O objetivo deste estudo é avaliar o impacto da ligadura elástica sobre a motilidade esofágica e sintomas antes e após a erradicação das varizes esofágicas. Foram avaliados pacientes com cirrose hepática portadores de varizes de esôfago passiveis de terapêutica endoscópica. Aplicou-se um questionário padronizado de sintomas do trato digestivo alto, manometria convencional esofágica de 8 canais e estudo do trânsito esofágico por cintilografia marcado com tecnécio-99m antes da primeira ligadura elástica e até 2 semanas após a constatação da erradicação das varizes. Dos 101 pacientes iniciados, concluiu-se todos os exames e questionários em 65 pacientes, cuja média de idade foi de 59,5±11,2 anos, 43 (67,7%) eram homens, 47 (72,3%) eram Child-Pugh A e as etiologias mais frequentes foram 22 (33,9%) VHC e 17 (26,2%) etilismo. Os resultados mostraram que na manometria esofágica não houve diferenças na pressão basal e no relaxamento dos esfíncteres. No corpo esofágico não houve alteração no peristaltismo, mas ocorreu aumento na pressão de amplitude na altura de 3cm a montante do esfíncter inferior de 72,8±39,4mmHg para 81,4±40,1mmHg (p=0,015). No ensaio do trânsito esofágico por cintilografia ocorreu elevação do tempo no seguimento inferior do esôfago de 17,7±10,5 segundos para 20,9±12,9 segundos (p=0,043), demais seguimentos, coordenação e retenção não tiveram diferença estatística. Após a erradicação das varizes todos os sintomas abordados não tiveram diferença significativa em relação ao questionamento inicial. Conclui-se que não houve mudanças nos sintomas do trato digestivo alto antes e após a ligadura elástica. Todavia, concluiu-se que a ligadura elástica pode causar alterações da motilidade esofágica no seu terço distal aferidas, tanto na manometria como na cintilografia e que tais modificações foram incapazes de promover sintomas ao paciente.
Evaluation of esophageal motility after endoscopic variceal ligation. 2020. Doctoral thesis – Medical School, Botucatu. São Paulo State University (Unesp), 2020. Endoscopic variceal ligation is the most indicated procedure for the primary and secondary prevention of variceal bleeding. The aim of this study is to evaluate the impact of variceal ligation on esophageal motility and symptoms before and after the eradication of esophageal varices. Patients with liver cirrhosis with esophageal varicose veins amenable to endoscopic therapy were evaluated. We applied a standardized questionnaire of upper digestive tract symptoms, conventional 8-channel esophageal manometry, and study of technetium-99m scintigraphy esophageal transit before the first variceal ligation and up to 2 weeks after finding varicose vein eradication. From 101 initiated patients, all examinations and questionnaires were completed in 65 patients, whose average age was 59.5±1.2 years, 43 (67.7%) were men, 47 (72.3%) were Child A and the most frequent etiologies were 22 (33.9%) HCV and 17 (26.2%) alcoholism. The results showed that in esophageal manometry there were no differences in basal pressure and sphincters relaxation. In the esophageal body there was no change in peristalsis, but there was an increase in amplitude pressure 3cm upstream of the lower sphincter from 72.8±39.4mmHg to 81.4±40.1mmHg (p=0.015). In the esophageal transit test by scintigraphy there was an increase in time in the lower esophageal follow-up from 17.7±10.5 sec. to 20.9±12.9 seconds (p=0.043), other follow-ups, coordination and retention had no statistical difference. After the eradication of varices all the symptoms addressed had no significant difference in relation to the initial questioning. It was concluded that there were no changes in the symptoms of the upper digestive tract before and after the variceal ligation. However, it was concluded that the variceal ligation can cause changes in esophageal motility in the distal third measured, both in manometry and scintigraphy, and that such changes were unable to promote symptoms to the patient.
Evaluation of esophageal motility after endoscopic variceal ligation. 2020. Doctoral thesis – Medical School, Botucatu. São Paulo State University (Unesp), 2020. Endoscopic variceal ligation is the most indicated procedure for the primary and secondary prevention of variceal bleeding. The aim of this study is to evaluate the impact of variceal ligation on esophageal motility and symptoms before and after the eradication of esophageal varices. Patients with liver cirrhosis with esophageal varicose veins amenable to endoscopic therapy were evaluated. We applied a standardized questionnaire of upper digestive tract symptoms, conventional 8-channel esophageal manometry, and study of technetium-99m scintigraphy esophageal transit before the first variceal ligation and up to 2 weeks after finding varicose vein eradication. From 101 initiated patients, all examinations and questionnaires were completed in 65 patients, whose average age was 59.5±1.2 years, 43 (67.7%) were men, 47 (72.3%) were Child A and the most frequent etiologies were 22 (33.9%) HCV and 17 (26.2%) alcoholism. The results showed that in esophageal manometry there were no differences in basal pressure and sphincters relaxation. In the esophageal body there was no change in peristalsis, but there was an increase in amplitude pressure 3cm upstream of the lower sphincter from 72.8±39.4mmHg to 81.4±40.1mmHg (p=0.015). In the esophageal transit test by scintigraphy there was an increase in time in the lower esophageal follow-up from 17.7±10.5 sec. to 20.9±12.9 seconds (p=0.043), other follow-ups, coordination and retention had no statistical difference. After the eradication of varices all the symptoms addressed had no significant difference in relation to the initial questioning. It was concluded that there were no changes in the symptoms of the upper digestive tract before and after the variceal ligation. However, it was concluded that the variceal ligation can cause changes in esophageal motility in the distal third measured, both in manometry and scintigraphy, and that such changes were unable to promote symptoms to the patient.
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Palavras-chave
Esôfago, Motilidade do esôfago, Ligadura elástica, Varizes esofágicas, Manometria do esôfago, Cintilografia, Esophageal, Esophageal motility, Esophageal varices, Ligation, Esophageal manometry, Scintigraphy