Perendoscopic variceal pressure measurement: a reliable estimation of portal pressure in patients with cirrhosis?
OBJECTIVE
In patients with cirrhosis, the hepatic venous pressure gradient (HVPG) is the reference method for the assessment of portal hypertension (PHT). Variceal pressure (VP) may be measured at endoscopy, but its relationship to the HVPG remains controversial. The aim of the study was to retrospectively compare HVPG and VP values obtained in a cohort of patients with cirrhosis and PHT.


METHODS
Within 8 days (range: 6-10 days), 64 patients in a stable condition with biopsy-proven cirrhosis [alcoholic: 47; other 17; mean age: 56.5 yrs (35-70); mean Child-Pugh's score: 9.4 +/- 1.9; ascites: 37/64; previous variceal bleeding (="bleeders"): 24/64) and oesophageal varices (grade 2: 49; grade 3: 15)] underwent both measurement of the HVPG during transjugular liver biopsy and VP at endoscopy using a "home made" pressure sensitive gauge in the absence of needle puncture of the varix. Alcoholic hepatitis was present in 28 patients with alcoholic cirrhosis.


RESULTS
The pressure sensitive gauge was well tolerated. The mean HVPG and VP values were 18.5 +/- 3.4 mmHg and 19 +/- 3.7 mmHg, respectively. A significant difference was observed between "bleeders" (n=24) and non "bleeders" (n=40) in terms of VP values (21.4 +/- 3.3 vs 17.2 +/- 3.2 mmHg, P<0.001), but not for HVPG values (19.4 +/- 4.1 vs 17.9 +/- 2.8 mmHg, P=0.075). A positive correlation was observed between VP and HVPG values (r=0.62, P<0.0001).


CONCLUSIONS
In this group of patients with cirrhosis and oesophageal varices, a "home-made" pressure sensitive gauge allowed a non invasive perendoscopic measurement of VP. The positive correlation between VP and HVPG values suggests that measurement of VP may be a reliable estimate of portal pressure in these patients.
Spahr
Laurent
L
Gastroenterogy and Hepatology, Hôpitaux Universitaire de Genève, 24 Rue Micheli-du-Crest, 1211 Geneva 4, Switzerland. Laurent.Spahr@hcuge.ch
Giostra
Emile
E
Morard
Isabelle
I
Mentha
Gilles
G
Hadengue
Antoine
A
D000328:Adult; D000368:Aged; D001795:Blood Pressure Determination / Q000295:instrumentation; D004867:Equipment Design; D004932:Esophageal and Gastric Varices / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014690:Venous Pressure / Q000502:physiology*