Esophageal acid-clearance and motility after endoscopic sclerotherapy of esophageal varices

Abstract

To investigate the possible mechanisms which may lead to esophageal strictures after endoscopic variceal sclerotherapy, we performed esophageal motility and acid-clearance studies before and after 24 sclerotherapy sessions in 10 patients. Comparing studies before and after sclerotherapy, we found: a 93% mean increase in the number of swallows required to clear a standard amount of administered acid 24 h after sclerotherapy. Acid clearance returned to baseline within 1 wk of sclerotherapy; minimal changes in esophageal motility, none of which was significant except for swallow-induced simultaneous contractions in the distal esophagus which were a prominent feature in manometric recordings within 24 h of sclerotherapy; no increase in acid reflux from the stomach. We conclude that acid clearance from the distal esophagus is markedly delayed for at least 24 h by sclerotherapy but that this defect in acid clearance is transient, lasting no more than 1 wk. The importance of this observation remains to be demonstrated, but it is consistent with the concept that acid-induced injury contributes to the formation of post-sclerotherapy strictures.