Minimally invasive measurement of esophageal variceal pressure and wall tension (with video).
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.
Vegesna
Anil K
AK
Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
Chung
Chan Y
CY
Bajaj
Anurag
A
Tiwana
Mansoor I
MI
Rishikesh
Ranjitha
R
Hamid
Imran
I
Kalra
Amit
A
Korimilli
Annapurna
A
Patel
Sapna
S
Mamoon
Rasheed
R
Riaz
Jahenzeb
J
Miller
Larry S
LS
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