Hemodynamic features of gastrorenal shunt: a Doppler study in cirrhotic patients with gastric fundal varices.
OBJECTIVE
Little is known about the hemodynamics of gastrorenal shunt (GRS), a major drainage route of gastric fundal varices (FV), in patients with FV. The aim of this study was to clarify the hemodynamic features of GRS on Doppler sonography in relation to the grading and bleeding of FV.


METHODS
The study subjects consisted of 69 cirrhotic patients with FV. Diameter, flow velocity (FVe), and flow volume (FVo) of GRS were measured by Doppler ultrasound (US). The detection rate was compared to contrast-enhanced computed tomography (CECT), and percutaneous transhepatic portography (PTP) was used in six patients without GRS on CECT.


RESULTS
The use of CECT detected GRS in 60 of 69 patients, and US, 58 of 69 patients. A false-negative result for detecting GRS on both CECT and US was found in one patient after PTP. The diameter, FVe, and FVo of GRS increased according to the endoscopic grade of FV: F1 (7.2+/-1.3 mm, 9.8+/-1.1 cm/s, 358.3+/-123.4 ml/min), F2 (9.9+/-3.3 mm, 12.8+/-5.1 cm/s, 701.7+/-411.3 ml/min), and F3 (11.8+/-2.4 mm, 17.9+/-8.3 cm/s, 1706.6+/-989.5 ml/min). A significant difference was seen between F1 and F3 (diameter, P=.0022; FVe, P=.0133; FVo, P=.0007) and between F2 and F3 (FVe, P=.0112; FVo, P<.0001). FVe of GRS was significantly higher in bleeders (16.7+/-8.1 cm/s) than in nonbleeders (12.2+/-5.4 cm/s, P=.017), whereas the diameter and FVo were not significant.


CONCLUSIONS
Hemodynamics of GRS on Doppler sonograms reflected the grading and bleeding of FV. Doppler US may be valuable as a noninvasive method to evaluate the severity of FV.
Maruyama
Hitoshi
H
Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba, 260-8670, Japan. maru-cib@umin.ac.jp
Okugawa
Hidehiro
H
Yoshizumi
Hiroaki
H
Kobayashi
Satoshi
S
Yokosuka
Osamu
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005748:Gastric Fundus; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler