Background and aim: Pregnancy is unusual in women with portal hypertension
and liver cirrhosis. Variceal bleeding occurs in about 33-45%
of these patients. This study was designed to evaluate eruloscopic band
ligation in controlling variceal bleeding episodes in pregnant women with
cirrhotic liver and portal hypertension.
Methods: Ten pregnant women with liver cirrhosis and portal hypertension
were followed up over a period of 2.5 years in conjunction with
obstetric evaluation and follow up till delivery. Assessment of general parameters
together with liver function was carried on. Endoscopic band ligation
was performed in all cases.
Results: Three cases were presented to the hospital by an acute vanceal
bleeding episode. These cases hod GIV oesophageal varices on endoscopy.
The remaining seven cases showed oesophageal varices
on routine endoscopy for occult blood in stool (5 cases) and melena (2 cases).
Variceal band ligation was carried on to all patients. Five patients
had second session of banding after one week. Three patients had a
third session after two weeks, one of them died from massive variceal
bleeding episode on the 5th day after the 3rd session. The obstetric performance
of the remaining 9 cases showed that only 4 cases (44.4%)
could be carried to term pregnancy. The main complications were preterm
labor (3 cases), intrauterine fetal death (one case), intrauterine growth retardation
(one case). After successful banding, no cases of bleeding oe-
sophageal varices were recorded during the course of pregnancy or labor.
Endoscopic reevaluation one month after delivery showed complete vanceal
obliteration in 4 cases, partial obliteration in 3 cases and GI-II oesophageal
varices in one case.
Conclusion: Endoscopic band ligation represents a safe and efficient
method for prophylcvcis and control of oesophageal varices bleeding episodes
in pregnant women with liver cirrhosis and portal hypertension. |
