Blood flow parameters in the short gastric vein and splenic vein on Doppler ultrasound reflect gastric variceal bleeding.
OBJECTIVE
Hemodynamic features associated with the bleeding from gastric fundal varices (FV) have not been fully examined. The purpose of this study was to elucidate hemodynamics in the short gastric vein (SGV) which is a major inflow route for FV and flow direction of the splenic vein (SV) in relation to bleeding FV.


METHODS
The subject of this retrospective study was 54 cirrhotic patients who had medium- or large-sized FV (20 bleeders, 34 non-bleeders) on endoscopy with SGV on both angiogram and sonogram. Diameter, flow velocity, flow volume of SGV and flow direction in the SV were evaluated by Doppler ultrasound.


RESULTS
Diameter, flow velocity and flow volume of SGV were significantly greater in bleeders (9.6+/-3.1 mm, 11.4+/-5.2 cm/s, 499+/-250.1 ml/min) than non-bleeders (6.5+/-2.2 mm, p=0.0141; 7.9+/-3.3 cm/s, p=0.022; 205+/-129.1 ml/min, p=0.0031). SV showed forward flow in 37 (68.5%), to and fro in 3 (5.6%) and reversed flow in 14 patients (25.9%). The frequency of FV bleeding was significantly higher in case with reversed or "to and fro" SV flow (11/17) than forward SV flow (9/37, p=0.0043). The cumulative bleeding rate at 3 and 5 years was significantly higher in patients without forward SV flow (38.8% at 3 years, 59.2% at 5 years) than in patients with forward SV flow (18.7% at 3 years, 32.2% at 5 years, p=0.0199).


CONCLUSIONS
Advanced SGV blood flow and reversed SV flow direction may be a hemodynamic features closely related to the FV bleeding.
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
Ishihara
Takeshi
T
Ishii
Hiroshi
H
Tsuyuguchi
Toshio
T
Yoshikawa
Masaharu
M
Matsutani
Shoichi
S
Yokosuka
Osamu
O
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013270:Stomach / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018608:Ultrasonography, Doppler / Q000379:methods*