Document Detail


Minimally invasive measurement of esophageal variceal pressure and wall tension (with video).
MedLine Citation:
PMID:  19699975     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is no simple method to measure intravariceal pressure in patients with esophageal varices. OBJECTIVE: Our purpose was to develop a new noninvasive technique to measure resting intravariceal pressure and wall tension. DESIGN: A model was developed. A long balloon (varix) was fitted inside an airtight cylinder (esophagus). Fluid ran through the model varices to maintain 5 different constant pressures. An endoscope was placed in the model esophagus, and pressure was increased by air insufflation. The endoscopy and pressure readings from the esophagus and varix were recorded continuously until variceal collapse. SETTING: Patient studies were done in an endoscopy suite with the patient under fentanyl and midazolam sedation. PATIENTS: Esophageal pressure was measured during air insufflation in patients with varices until the varices collapsed. EUS was used to measure radius and wall thickness to calculate wall tension. RESULTS: In the varix model, the mean (SD) intraluminal esophageal pressures at variceal flattening for the model varices at 5, 10, 15, 20, and 25 mm Hg were 5.69 (0.34), 11 (0.32), 15.72 (0.51), 21.55 (0.63), and 25.8 (0.14) mm Hg. The correlation between actual and measured variceal pressure in the model at variceal flattening was r = 0.98. In the patients, a total of 10 varices in 3 patients were evaluated. The mean (SD) for the varices in each subject was 12.16 (2.4), 23.2 (1.3), and 6.5 (2.2) mm Hg for subjects 1, 2, and 3, respectively. CONCLUSION: Standard endoscopy with air insufflation and manometry can be used as an accurate, simple, and reproducible method to measure intravariceal pressure.
Authors:
Anil K Vegesna; Chan Y Chung; Anurag Bajaj; Mansoor I Tiwana; Ranjitha Rishikesh; Imran Hamid; Amit Kalra; Annapurna Korimilli; Sapna Patel; Rasheed Mamoon; Jahenzeb Riaz; Larry S Miller
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  70     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-24     Completed Date:  2009-12-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  407-13     Citation Subset:  IM    
Affiliation:
Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
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MeSH Terms
Descriptor/Qualifier:
Endosonography / methods
Esophageal and Gastric Varices / complications,  diagnosis*
Esophagoscopy / methods*
Esophagus / blood supply
Gastrointestinal Hemorrhage / etiology,  prevention & control
Humans
Insufflation
Male
Manometry / methods*
Middle Aged
Models, Theoretical
Muscle, Smooth, Vascular / physiology
Pressure
Risk Assessment
Sensitivity and Specificity
Signal Processing, Computer-Assisted*
Tensile Strength
Video Recording
Comments/Corrections
Comment In:
Gastrointest Endosc. 2009 Sep;70(3):414-6   [PMID:  19699976 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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