Doppler ultrasound could predict varices progression and rebleeding after portal hypertension surgery: lessons from 146 EGDS and 10 years of follow-up.
BACKGROUND
Surgical treatment of variceal hemorrhagic complications for patients with schistosomal portal hypertension in our group comprised an esophagogastric devascularization procedure with splenectomy (EGDS). There are two different kinds of postoperative follow-up: prophylactic or on-demand endoscopic program of varices eradication. This program implies risks and costs and only proves necessary in 6-29% of cases. This study was designed to assess portal vein Doppler ultrasound data in these patients, and to verify correlations with progression in the number and size of varices, as well as the appearance of red spots and rebleeding during the postoperative period after EGDS.


METHODS
Data on portal vein Doppler ultrasound from 146 patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophagogastric varices rupture was analyzed. All subjects underwent EGDS and were analyzed before and after the procedure and compared postoperatively at four time points: 1 year, 2 years, up to 5 years, and up to 10 years. The following portal hemodynamic parameters were analyzed: diameter and mean blood flow velocity. Variceal size and number, presence of red spots, and rebleeding were all determined by endoscopic examination. Patients were divided into two groups at the each of the four time points, according to esophagogastric varices progression.


RESULTS
Patients with variceal progression had significantly higher values of portal blood flow velocity. At time points I, II, III, and IV, the measured flow velocity from first postoperative year was 17.64 +/- 4.84 vs. 13.81 +/- 5.61 (p = 0.025); 16.74 +/- 4.8 vs. 13.75 +/- 5.8 (p = 0.039); 16.01 +/- 5.00 vs. 13.23 +/- 5.86 (p = 0.036); and 16.01 +/- 5.00 vs. 13.23 +/- 5.86 (p = 0.036), respectively.


CONCLUSIONS
Patients with schistosomal portal hypertension submitted to EGDS who had portal blood flow velocity >15.5 cm per second at the first postoperative year ha d progression of esophagogastric varices and a greater chance of rebleeding and, therefore, should be included in the endoscopic program for varices eradication.
Ferreira
Fabio Gonçalves
FG
Liver and Portal Hypertension Group-Surgery Department, Santa Casa School of Medical Sciences, Sao Paulo, SP, Brazil. drfabioferreira@uol.com.br
Ribeiro
Maurício Alves
MA
de Fátima Santos
Maria
M
Assef
José César
JC
Szutan
Luiz Arnaldo
LA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D013505:Digestive System Surgical Procedures / Q000379:methods; D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012555:Schistosomiasis mansoni / Q000150:complications*; D013156:Splenectomy; D018608:Ultrasonography, Doppler; D055815:Young Adult