Noninvasive endoscopic determination of intravariceal pressure in patients with portal hypertension: clinical experience with a new balloon technique.
OBJECTIVE
Recently, details of a noninvasive balloon manometry technique for endoscopic measurement of variceal pressure (VP) have been published. However, to date, only few data exist on its feasibility and virtually none on its relation to endoscopic or clinical variables of portal hypertension.


METHODS
We investigated a total of 64 patients with esophageal varices using a scaled transparent balloon and a calibrated pressure manometer. Averaged from both fivefold balloon insufflation (variceal collapse) or desufflation (variceal appearance), we took measurements of the VP (mmHg) using the two techniques. These measurements were correlated between two investigators as well as to both clinical and endoscopic signs of portal hypertension. Furthermore, pressures were assessed prospectively before and during propranolol application.


RESULTS
Measurements were successful in > 95% of all sessions without side effects. The intraobserver variance was 11.0 +/- 13.1%. Measurements correlated significantly between two observers (r = 0.80, insufflation technique, p < 0.01/r = 0.81, desufflation technique, p < 0.01). Pressures correlated positively to variceal sizes (p < 0.05). The presence of fundic varices was strongly associated with higher pressures (p < 0.02). In patients without medical decompressive therapy we found a significant relationship between VP and the presence of red colour signs or previous bleeding episodes. Clinical parameters did not correlate with VP (p > 0.05). As assessed by this technique, 8/11 patients receiving propranolol showed a decrease in VP (18.6 +/- 19.5% after 1.5 months and 33.3 +/- 11.9% after 3 months).


CONCLUSIONS
This noninvasive balloon technique is a safe and practical method for estimating VP in patients with portal hypertension. As found by invasive methods, patients with large varices and concomitant fundic varices have higher VP. A drop in intravariceal pressure after propranolol therapy appears to be assessable.
Department of General Internal Medicine, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany.
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Scheurlen
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Roleff
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Neubrand
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Sauerbruch
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D016022:Case-Control Studies; D016145:Endoscopy, Digestive System / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008365:Manometry / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D011312:Pressure; D011433:Propranolol / Q000008:administration & dosage; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D000959:Antihypertensive Agents; D011433:Propranolol