title: Minimally invasive measurement of esophageal variceal pressure and wall tension (with video).
abstract: BACKGROUND
  There is no simple method to measure intravariceal pressure in patients with esophageal varices.
  
  
  OBJECTIVE
  Our purpose was to develop a new noninvasive technique to measure resting intravariceal pressure and wall tension.
  
  
  METHODS
  A model was developed. A long balloon (varix) was fitted inside an airtight cylinder (esophagus). Fluid ran through the model varices to maintain 5 different constant pressures. An endoscope was placed in the model esophagus, and pressure was increased by air insufflation. The endoscopy and pressure readings from the esophagus and varix were recorded continuously until variceal collapse.
  
  
  METHODS
  Patient studies were done in an endoscopy suite with the patient under fentanyl and midazolam sedation.
  
  
  METHODS
  Esophageal pressure was measured during air insufflation in patients with varices until the varices collapsed. EUS was used to measure radius and wall thickness to calculate wall tension.
  
  
  RESULTS
  In the varix model, the mean (SD) intraluminal esophageal pressures at variceal flattening for the model varices at 5, 10, 15, 20, and 25 mm Hg were 5.69 (0.34), 11 (0.32), 15.72 (0.51), 21.55 (0.63), and 25.8 (0.14) mm Hg. The correlation between actual and measured variceal pressure in the model at variceal flattening was r = 0.98. In the patients, a total of 10 varices in 3 patients were evaluated. The mean (SD) for the varices in each subject was 12.16 (2.4), 23.2 (1.3), and 6.5 (2.2) mm Hg for subjects 1, 2, and 3, respectively.
  
  
  CONCLUSIONS
  Standard endoscopy with air insufflation and manometry can be used as an accurate, simple, and reproducible method to measure intravariceal pressure.
authors.affiliation: Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Vegesna
authors.forename: Chan Y
authors.initials: CY
authors.lastname: Chung
authors.forename: Anurag
authors.initials: A
authors.lastname: Bajaj
authors.forename: Mansoor I
authors.initials: MI
authors.lastname: Tiwana
authors.forename: Ranjitha
authors.initials: R
authors.lastname: Rishikesh
authors.forename: Imran
authors.initials: I
authors.lastname: Hamid
authors.forename: Amit
authors.initials: A
authors.lastname: Kalra
authors.forename: Annapurna
authors.initials: A
authors.lastname: Korimilli
authors.forename: Sapna
authors.initials: S
authors.lastname: Patel
authors.forename: Rasheed
authors.initials: R
authors.lastname: Mamoon
authors.forename: Jahenzeb
authors.initials: J
authors.lastname: Riaz
authors.forename: Larry S
authors.initials: LS
authors.lastname: Miller
mesh_terms: D019160:Endosonography / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000098:blood supply; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007327:Insufflation; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D008962:Models, Theoretical; D009131:Muscle, Smooth, Vascular / Q000502:physiology; D011312:Pressure; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D013718:Tensile Strength; D014741:Video Recording