New abdominal collaterals at ultrasound: a clue of progression of portal hypertension.
BACKGROUND
Abdominal ultrasound can detect non-invasively the presence of abdominal portal-systemic collaterals in patients with liver cirrhosis. Abdominal portal-systemic collaterals may be protective from the formation and growth of oesophageal varices, but available data are inconclusive.


OBJECTIVE
We aimed at investigating the relationship between abdominal portal-systemic collaterals and variceal formation and growth.


METHODS
We studied 126 cirrhotic patients without (n=43) or with small (n=83) oesophageal varices who entered a protocol of serial ultrasonographic and endoscopic examinations for a median of 55 months. Presence and kind of abdominal portal-systemic collaterals was recorded on first ultrasonography and on each control thereafter.


RESULTS
At inclusion, abdominal portal-systemic collaterals were found in 19/43 patients without varices and in 23/83 patients with small varices (NS). There was no difference in variceal formation and growth between patients with and without abdominal portal-systemic collaterals at inclusion. However, patients developing new abdominal portal-systemic collaterals during follow-up had a significantly higher rate of variceal formation (56.2% vs. 22.2%; p=0.024) and growth (52.9% vs. 30.6%; p=0.041) compared with patients with unchanged ultrasonography.


CONCLUSIONS
Abdominal collaterals are not protective from the formation or growth of oesophageal varices. Conversely, new abdominal portal-systemic collaterals emergence is a non-invasive clue of formation and progression of varices. Therefore, endoscopy is probably indicated whenever new abdominal portal-systemic collaterals are detected in cirrhotic patients.
Berzigotti
A
A
Department of Internal Medicine, Cardioangiology, Hepatology, University of Bologna, Italy.
Merkel
C
C
Magalotti
D
D
Tiani
C
C
Gaiani
S
S
Sacerdoti
D
D
Zoli
M
M
D000005:Abdomen; D001783:Blood Flow Velocity; D003097:Collateral Circulation / Q000502:physiology*; D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D004947:Esophagus / Q000098:blood supply*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler / Q000379:methods*