Document Detail


Sequential variceal pressure measurement by endoscopic needle puncture during maintenance sclerotherapy: the correlation between variceal pressure and variceal rebleeding.
MedLine Citation:
PMID:  9833915     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/AIMS: The risk factors for esophageal variceal rebleeding are little known. Variceal pressure is one of the major determinants of variceal rupture, but the relationship between variceal pressure and variceal rebleeding during maintenance sclerotherapy has not been determined. This study was undertaken to evaluate the relationship between variceal pressure/gradient change and variceal rebleeding during maintenance sclerotherapy. METHODS: Patients with liver cirrhosis and recent esophageal variceal hemorrhage underwent consecutive variceal pressure measurements by direct puncture of the varices before each elective sclerotherapy. RESULTS: In 46 patients, the initial variceal pressure was no different regardless of age, sex, underlying etiology or hepatic reserve. Variceal pressure was higher in large varices, varices with more severe red wale markings, and varices with slower reduction in size during maintenance sclerotherapy. A larger volume of sclerosant was required to eradicate large varices, varices with more severe red wale markings, and varices with slower reduction in size during maintenance sclerotherapy. There was a positive correlation between initial variceal pressure and total amount of sclerosant (r=0.485, p=0.001). Initial variceal pressure was not related to rebleeding. Variceal pressure increased more in patients with rebleeding from varices per se (n=7) than in those without rebleeding (n= 24). There was no difference in pressure change between patients without rebleeding (n=24) and those with rebleeding from variceal ulcers (n=7). CONCLUSIONS: Large varices, severe red color signs and slow reduction in variceal size were associated with higher initial variceal pressure, and more sclerosant was required to eradicate the varices. An increase in variceal pressure during maintenance sclerotherapy indicates a higher risk of variceal rebleeding, but not of variceal ulcer rebleeding.
Authors:
M C Hou; H C Lin; B I Kuo; T M Liao; F Y Lee; F Y Chang; S D Lee
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of hepatology     Volume:  29     ISSN:  0168-8278     ISO Abbreviation:  J. Hepatol.     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1999-02-10     Completed Date:  1999-02-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8503886     Medline TA:  J Hepatol     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  772-8     Citation Subset:  IM    
Affiliation:
Department of Medicine, Veterans General Hospital-Taipei and National Yang-Ming University School of Medicine, Taiwan, Republic of China.
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MeSH Terms
Descriptor/Qualifier:
Aged
Esophageal and Gastric Varices / physiopathology*
Esophagoscopes
Esophagoscopy / adverse effects
Female
Gastrointestinal Hemorrhage / etiology*,  physiopathology,  therapy*
Humans
Liver Cirrhosis / complications*,  physiopathology
Male
Middle Aged
Punctures
Sclerotherapy / adverse effects*,  instrumentation,  methods
Comments/Corrections
Comment In:
J Hepatol. 1998 Nov;29(5):829-31   [PMID:  9833924 ]

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


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