Noninvasive measurement of the pressure of esophageal varices using an endoscopic gauge: Comparison with measurements by variceal puncture in patients undergoing endoscopic sclerotherapy
✍ Scribed by Jaime Bosch; José M. Bordas; Joaquín Rigau; Carmen Viola; Ricardo Mastai; David Kravetz; Miguel Navasa; Joan Rodés
- Publisher
- John Wiley and Sons
- Year
- 1986
- Tongue
- English
- Weight
- 756 KB
- Volume
- 6
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
Measurements of variceal pressure with a noninvasive endoscopic pressure gauge and by direct variceal puncture were performed in 20 cirrhotic patients with portal hypertension in the course of the first session of therapeutic sclerotherapy following an episode of variceal bleeding.
Endoscopic gauge measurements of the pressure of esophageal varices gave similar values (15.5 f 2.7 mm Hg) than measurements by variceal puncture (15.4 f 2.4 mm Hg; not statistically significant), and there was a highly significant linear correlation between both measurements (r = 0.9, p < 0.001). Azygos blood flow, that was markedly increased in these patients (852 f 399 ml per min), was directly related to variceal pressure (r = 0.73, p < 0.01). Variceal pressure was significantly lower than portal pressure (18.8 2 5.0 mm Hg) (p c 0.06), indicating that measurements of variceal pressure cannot substitute measurements of portal pressure.
The study demonstrates that the noninvasive endoscopic gauge teehnique allows an accurate estimation of variceal pressure in patients with portal hypertension. This technique may provide additional useful information in the evaluation of portal hypertension as well as on the mechanism of variceal bleeding.
Variceal bleeding is the most frequent and severe complication of portal hypertension, and represents a common cause of death in patients with cirrhosis (1, 2). However, despite the increasing effort in research in this field, the mechanism of variceal bleeding remains poorly understood. Measurement of portal pressure has little, if any, predictive value (3-5), and the same happens with measurements of azygos blood flow (6), a recently introduced technique for the estimation of blood flow through