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. 1989 Feb;30(2):228–232. doi: 10.1136/gut.30.2.228

Pressure of intraoesophageal varices assessed by fine needle puncture: its relation to endoscopic signs and severity of liver disease in patients with cirrhosis.

G Kleber 1, T Sauerbruch 1, G Fischer 1, G Paumgartner 1
PMCID: PMC1378306  PMID: 2703144

Abstract

In 40 patients with cirrhosis and oesophageal varices transmural variceal pressure was assessed endoscopically by fine needle puncture and related to endoscopic signs as well as to the severity of liver disease. Transmural pressure was significantly (p less than 0.01) higher in the presence of a red colour sign (26.7 (7.8) cm H2O) than in its absence (19.1 (6.6) cm H2O). Transmural pressure, however, was not significantly related to diameter or number of varices (diameter greater than 5 mm: 23.7 (8.4), diameter less than or equal to 5 mm: 22.2 (7.9) cm H2O; number greater than 3: 23.2 (8.0), number less than or equal to 3: 22.2 (7.8) cm H2O). The Child status (Child A: 23.9 (8.0), Child B/C: 21.3 (8.1) cm H2O) and individual Child-Pugh parameters including ascites (ascites present: 23.2 (8.3) cm H2O ascites absent: 22.8 (8.1) cm H2O) were not significantly related to transmural variceal pressure. We conclude that the endoscopic visibility of a red colour sign on the varices is associated with a high transmural oesophageal variceal pressure. Our results favour the hypothesis that variceal pressure may be of major importance for the development of the red colour sign.

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Selected References

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  1. Beppu K., Inokuchi K., Koyanagi N., Nakayama S., Sakata H., Kitano S., Kobayashi M. Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc. 1981 Nov;27(4):213–218. doi: 10.1016/s0016-5107(81)73224-3. [DOI] [PubMed] [Google Scholar]
  2. Bosch J., Groszmann R. J. Measurement of azygos venous blood flow by a continuous thermal dilution technique: an index of blood flow through gastroesophageal collaterals in cirrhosis. Hepatology. 1984 May-Jun;4(3):424–429. doi: 10.1002/hep.1840040312. [DOI] [PubMed] [Google Scholar]
  3. Braillon A., Cales P., Valla D., Gaudy D., Geoffroy P., Lebrec D. Influence of the degree of liver failure on systemic and splanchnic haemodynamics and on response to propranolol in patients with cirrhosis. Gut. 1986 Oct;27(10):1204–1209. doi: 10.1136/gut.27.10.1204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Cheli R., Simon L., Elster K., Bocchini R. Oesophagitis in Italian and Hungarian asymptomatic subjects. Endoscopy. 1982 Jan;14(1):1–3. doi: 10.1055/s-2007-1021559. [DOI] [PubMed] [Google Scholar]
  5. Conn H. O., Lindenmuth W. W., May C. J., Ramsby G. R. Prophylactic portacaval anastomosis. Medicine (Baltimore) 1972 Jan;51(1):27–40. doi: 10.1097/00005792-197201000-00002. [DOI] [PubMed] [Google Scholar]
  6. Ginés P., Arroyo V., Quintero E., Planas R., Bory F., Cabrera J., Rimola A., Viver J., Camps J., Jiménez W. Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study. Gastroenterology. 1987 Aug;93(2):234–241. doi: 10.1016/0016-5085(87)91007-9. [DOI] [PubMed] [Google Scholar]
  7. Hosking S. W., Robinson P., Johnson A. G. Usefulness of manometric assessment of varices in maintenance sclerotherapy. A controlled trial. Gastroenterology. 1987 Oct;93(4):846–851. doi: 10.1016/0016-5085(87)90449-5. [DOI] [PubMed] [Google Scholar]
  8. Iwatsuki S., Reynolds T. B. Effect of increased intraabdominal pressure on hepatic hemodynamics in patients with chronic liver disease and portal hypertension. Gastroenterology. 1973 Aug;65(2):294–299. [PubMed] [Google Scholar]
  9. Kashtan J., Green J. F., Parsons E. Q., Holcroft J. W. Hemodynamic effect of increased abdominal pressure. J Surg Res. 1981 Mar;30(3):249–255. doi: 10.1016/0022-4804(81)90156-6. [DOI] [PubMed] [Google Scholar]
  10. Kleber G., Sauerbruch T., Fischer G., Paumgartner G. Somatostatin does not reduce oesophageal variceal pressure in liver cirrhotics. Gut. 1988 Feb;29(2):153–156. doi: 10.1136/gut.29.2.153. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. PALMER E. D., BRICK I. B. Correlation between the severity of esophageal varices in portal cirrhosis and their propensity toward hemorrhage. Gastroenterology. 1956 Jan;30(1):85–90. [PubMed] [Google Scholar]
  12. Pugh R. N., Murray-Lyon I. M., Dawson J. L., Pietroni M. C., Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973 Aug;60(8):646–649. doi: 10.1002/bjs.1800600817. [DOI] [PubMed] [Google Scholar]
  13. REYNOLDS T. B., REDEKER A. G., GELLER H. M. Wedged hepatic venous pressure; a clinical evaluation. Am J Med. 1957 Mar;22(3):341–350. doi: 10.1016/0002-9343(57)90090-6. [DOI] [PubMed] [Google Scholar]
  14. Smith-Laing G., Camilo M. E., Dick R., Sherlock S. Percutaneous transhepatic portography in the assessment of portal hypertension. Clinical correlations and comparison of radiographic techniques. Gastroenterology. 1980 Feb;78(2):197–205. [PubMed] [Google Scholar]
  15. Spence R. A., Sloan J. M., Johnston G. W. Histologic factors of the esophageal transection ring as clues to the pathogenesis of bleeding varices. Surg Gynecol Obstet. 1984 Sep;159(3):253–259. [PubMed] [Google Scholar]
  16. Spence R. A., Sloan J. M., Johnston G. W. Oesophagitis in patients undergoing oesophageal transection for varices--a histological study. Br J Surg. 1983 Jun;70(6):332–334. doi: 10.1002/bjs.1800700608. [DOI] [PubMed] [Google Scholar]
  17. Staritz M., Poralla T., Meyer zum Büschenfelde K. H. Intravascular oesophageal variceal pressure (IOVP) assessed by endoscopic fine needle puncture under basal conditions, Valsalva's manoeuvre and after glyceryltrinitrate application. Gut. 1985 May;26(5):525–530. doi: 10.1136/gut.26.5.525. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Vinel J. P., Cassigneul J., Louis A., Levade M., Pascal J. P. Clinical and prognostic significance of portohepatic gradient in patients with cirrhosis. Surg Gynecol Obstet. 1982 Sep;155(3):347–352. [PubMed] [Google Scholar]

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