Effects of esophageal varices obliteration by endoscopic variceal sclerotherapy on asialoscintigraphy and liver function test
Introduction
Asialoglycoprotein (ASGP) is taken up by functioning hepatocytes via a specific interaction with the ASGP receptor, which is expressed only on the hepatocyte surface [1], [2], [3], [4]. Therefore, administration of 99mTc-galactosyl human serum albumin (99mTc-GSA), a radioactive glycoprotein analog of ASGP, allows for direct imaging of functioning hepatocytes [5], [6], [7]. This agent is also useful in evaluating hepatic functional reserve, as the number of hepatic ASGP receptors decrease in proportion to the severity of chronic liver diseases [8], [9], [10].
Hepatic reserve is determined by the number and function of individual hepatocytes, as well as the volume of hepatic blood flow. Serum concentration of total bile acid and ICG clearance are influenced by changes in hepatic blood flow or by the blocking of portosystemic shunts [11], [12], suggesting that a number of parameters of hepatic reserve may be affected by both hepatic blood flow as well as the number and function of individual hepatocytes.
It is possible that 99mTc-GSA scintigraphy is also influenced by hepatic circulation. However, to date there has been no study on the relation between hepatic circulation and asialoscintigraphy. Therefore, we investigate changes in the results of 99mTc-GSA scintigraphy before and after obstruction of the portosystemic shunt by endoscopic injection sclerotherapy (EIS).
Section snippets
Subjects
The subjects include 49 patients (35 males, 14 females) with liver cirrhosis who underwent sclerotherapy for esophageal varices at our hospital from April 1996 to July 1999. The mean age of participants is 61.4±10.4 years (range 37–81 years). Liver cirrhosis was related to type B or type C viral cirrhosis in 31 cases, alcoholic cirrhosis in 17 cases, and primary biliary cirrhosis in one case. The varices in all cases were classified as Form 2 or Form 3 with positive red color sign, according to
Portosystemic shunt on Doppler ultrasonoglaphy and enhanced spiral CT
Hepatofugal flow of the portal trunk and splenic vein was not detected on Doppler ultrasonography in any patients. Splenorenal and gastrorenal shunts were detected on enhanced CT in 14 patients. Reopening of umbilical vein was detected on enhanced CT in four patients. The inner wall of the esophagus was detected on enhanced CT in 47 patients. The vessels over the wall of paraesophageal region were suggested in three patients; all three patients had both gastrorenal shunt and esophageal varices.
Discussion
It has been reported that LHL15, an indicator of 99m-Tc-GSA scintigraphy, reflects the number of asialoglycoprotein receptors on the sinusoidal membrane of hepatocytes [11] which decreases in proportion to the severity of liver disease [19], [20]. Our results have shown that there is a significant correlation between LHL15 and Child–Pugh's score, a generally used indicator for hepatic reserve. On the other hand, HH15, an indicator for clearance of the blood ligand, is thought to be well
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