Effect of supplemental branched-chain amino acid-enriched nutrients during endoscopic injection sclerotherapy or endoscopic variceal ligation in patients with liver cirrhosis

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Background: : Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are hallmark treatments for esophageal varices. Protein energy malnutrition can worsen when dietary restrictions are a required part of these treatments for patients with liver cirrhosis (LC). The aim of this study was to evaluate the effect of supplemental branched-chain amino acid-enriched nutrients (BCAA-EN) during EIS or EVL. Methods We retrospectively analyzed patients with LC who underwent EIS or EVL in our hospital from November 2008 to January 2016. Of the 55 eligible patients, 15 received a restricted diet and the remaining 40 patients received a restricted diet plus supplemental BCAA-EN during EIS or EVL. To reduce selection bias, we used one-to-two propensity score matching; 14 patients were assigned to a control group, and 28 were assigned to a BCAAEN group. Various blood chemistry parameters were measured and compared before and after treatment. Results Albumin concentrations in serum declined significantly in the control group but not in the BCAA-EN group. In patients with a Child-Pugh score of 5, albumin in serum did not decrease significantly in either group, although it did decrease in patients with a Child-Pugh score of 6 or more in the control group and was maintained in the BCAA-EN group. Multivariate analysis showed that only supplemental BCAA-EN was associated with the maintenance of albumin in serum. Conclusions Supplemental BCAA-EN would be effective in the maintenance of albumin in the serum of patients undergoing EIS or EVL, particularly for patients with advanced liver dysfunction.