Journal of Gastroenterology

, Volume 51, Issue 9, pp 900–909 | Cite as

Hemodynamic effect of the left gastric artery on esophageal varices in patients with cirrhosis

  • Soichiro Kiyono
  • Hitoshi Maruyama
  • Takayuki Kondo
  • Tadashi Sekimoto
  • Taro Shimada
  • Masanori Takahashi
  • Osamu Yokosuka
Original Article—Liver, Pancreas, and Biliary Tract
First Online:
Received:
Accepted:

Abstract

Background

To examine the hemodynamic effect of the left gastric artery (LGA) on the esophageal varices (EV) in cirrhosis.

Methods

This was a prospective study performed in 48 cirrhosis patients (35 men, 13 women; median age 61.6 ± 11.3 years, range 38–83 years) with EV (medium 35, large 13), who underwent selective LGA angiography, hepatic venous catheterization, endoscopic ultrasonography (EUS) and Doppler ultrasonography before endoscopic treatment for EV. Angiographic findings including diameter of the main trunk, detection time of EV, and mild/severe degree of peripheral staining were assessed. The median period of post-treatment observation was 17.1 months.

Results

LGA angiograms were successfully obtained in 45/48 patients. EV were demonstrated in 45/45 patients, with a mean detection time of 6.9 s (2–21), which was longer in patients with variceal recurrence (7.0 s) than in those without (5.6 s, P = 0.480). The staining was mild in 25 patients (55.6 %) and severe in 20 patients (44.4 %), and portal hypertensive gastropathy was more frequent in the latter (13/20, 65.0 %) than in the former (7/25, 28.0 %, P = 0.013). Multivariate analysis showed that pre-treatment detection time (P = 0.04) and post-treatment submucosal vascular area at the cardia wall by EUS (P = 0.036) were significant factors for variceal recurrence. No other factors, including hepatic venous pressure gradient and Doppler parameters, showed significant relationships with the variceal recurrence.

Conclusions

The hemodynamics in the LGA may act as an initiator of variceal formation, showing close linkage with variceal recurrence, and independent of portal pressure.

Keywords

Left gastric artery Esophageal varices Cirrhosis Portal hypertension 
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Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Tsochatzis EA, Bosch J, Burroughs AK. Liver cirrhosis. Lancet. 2014;383:1749–61.CrossRefPubMedGoogle Scholar
  2. 2.
    Rodríguez-Vilarrupla A, Fernández M, Bosch J, et al. Current concepts on the pathophysiology of portal hypertension. Ann Hepatol. 2007;6:28–36.PubMedGoogle Scholar
  3. 3.
    Sanyal AJ, Bosch J, Blei A, et al. Portal hypertension and its complications. Gastroenterology. 2008;134:1715–28.CrossRefPubMedGoogle Scholar
  4. 4.
    Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46:922–38.CrossRefPubMedGoogle Scholar
  5. 5.
    Groszmann RJ, Garcia-Tsao G, Bosch J, et al. Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis. N Engl J Med. 2005;353:2254–61.CrossRefPubMedGoogle Scholar
  6. 6.
    Garcia-Tsao G, Bosch J. Management of varices and variceal hemorrhage in cirrhosis. N Engl J Med. 2010;362:823–32.CrossRefPubMedGoogle Scholar
  7. 7.
    Bilbao JI, Torres E, Martínez-Cuesta A. Non-traumatic abdominal emergencies: imaging and intervention in gastrointestinal hemorrhage and ischemia. Eur Radiol. 2002;12:2161–71.CrossRefPubMedGoogle Scholar
  8. 8.
    Vosshenrich R, Fischer U. Contrast-enhanced MR angiography of abdominal vessels: is there still a role for angiography? Eur Radiol. 2002;12:218–30.CrossRefPubMedGoogle Scholar
  9. 9.
    Bruix J, Sherman M. American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–2.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Tajiri T, Yoshida H, Obara K, et al. General rules for recording endo-scopic findings of esophagogastric varices (2nd ed.). Dig Endosc. 2010;22:1–9.CrossRefPubMedGoogle Scholar
  11. 11.
    McCormack TT, Sims J, Eyre-Brook I, et al. Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy? Gut. 1985;26:1226–32.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Takase Y, Shibuya S, Chikamori F, et al. Recurrence factors studied by percutaneous transhepatic portography before and after endoscopic sclerotherapy for esophageal varices. Hepatology. 1990;11:348–52.CrossRefPubMedGoogle Scholar
  13. 13.
    Nakamura S, Mitsunaga A, Murata Y, et al. Endoscopic induction of mucosal fibrosis by argon plasma coagulation (APC) for esophageal varices: A prospective randomized trial of ligation plus APC vs. ligation alone. Endoscopy. 2001;33:210–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Hashizume M, Kitano S, Sugimachi K, et al. Three-dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension. Hepatology. 1988;8:1482–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Irisawa A, Saito A, Obara K, et al. Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities: severe peri-esophageal collateral veins and large perforating veins. Gastrointest Endosc. 2001;53:77–84.CrossRefPubMedGoogle Scholar
  16. 16.
    Maruyama H, Kamezaki H, Kondo T, et al. Sonographic and clinical features of collateral vessels at the splenic hilum in cirrhosis. Clin Radiol. 2014;69:e140–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Bolondi L, Li Bassi S, Gaiani S, et al. Doppler flowmetry in portal hypertension. J Gastroenterol Hepatol. 1990;5:459–67.CrossRefPubMedGoogle Scholar
  18. 18.
    Debernardi-Venon W, Bandi JC, García-Pagán JC, et al. CO2 wedged hepatic venography in the evaluation of portal hypertension. Gut. 2000;46:856–60.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Naganuma H, Ishida H, Niizawa M, et al. Hepatic involvement in Osler-Weber-Rendu disease: findings on pulsed and color Doppler sonography. Am J Roentgenol. 1995;165:1421–5.CrossRefGoogle Scholar
  20. 20.
    Sekimoto T, Maruyama H, Kondo T, et al. Potential stagnation in the splanchnic hemodynamics demonstrated by the dynamic microbubble in chronic liver disease. J Gastroenterol Hepatol. 2015;30:1001–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Sato S, Ohnishi K, Sugita S, et al. Splenic artery and superior mesenteric artery blood flow: nonsurgical Doppler US measurement in healthy subjects and patients with chronic liver disease. Radiology. 1987;164:347–52.CrossRefPubMedGoogle Scholar
  22. 22.
    Bernardi M, Moreau R, Angeli P, et al. Mechanisms of decompensation and organ failure in cirrhosis: From peripheral arterial vasodilation to systemic inflammation hypothesis. J Hepatol. 2015;63:1272–84.CrossRefPubMedGoogle Scholar
  23. 23.
    Widrich WC, Srinivasan M, Semine MC, et al. Collateral pathwas of the left gastric vein in portal hypertension. Am J Roentogenol. 1984;142:375–82.CrossRefGoogle Scholar
  24. 24.
    Irisawa A, Obara K, Bhutani MS, et al. Role of para-esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis. J Gastroenterol Hepatol. 2003;18:309–14.CrossRefPubMedGoogle Scholar
  25. 25.
    Kuramochi A, Imazu H, Kakutani H, et al. Color Doppler endoscopic ultrasonography in identifying groups at a high-risk of recurrence of esophageal varices after endoscopic treatment. J Gastroenterol. 2007;42:219–24.CrossRefPubMedGoogle Scholar
  26. 26.
    Iwakiri Y, Groszmann RJ. The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule. Hepatology. 2006;43:S121–31.CrossRefPubMedGoogle Scholar
  27. 27.
    Bosch J, Garcia-Pagan JC. Complications of cirrhosis. I. Portal hypertension. J Hepatol. 2000;32:141–56.CrossRefPubMedGoogle Scholar
  28. 28.
    Wiest R, Groszmann RJ. Nitric oxide and portal hypertension: its role in the regulation of intrahepatic and splanchnic vascular resistance. Semin Liver Dis. 1999;19:411–26.CrossRefPubMedGoogle Scholar
  29. 29.
    Langer DA, Shah VH. Nitric oxide and portal hypertension: interface of vasoreactivity and angiogenesis. J Hepatol. 2006;44:209–16.CrossRefPubMedGoogle Scholar
  30. 30.
    Thuluvath P, Yoo H. Portal hypertensive gastropathy. Am J Gastroenterol. 2002;97:2973–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Tekola BD, Caldwell S. Approach to the management of portal hypertensive gastropathy and gastric antral vascular ectasia. Clin Liv Dis. 2012;1:163–6.CrossRefGoogle Scholar
  32. 32.
    Ferraz JG, Wallace JL. Underlying mechanisms of portal hypertensive gastropathy. J Clin Gastroenterol. 1997;25:S73–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Kumar A, Mishra SR, Sharma P, et al. Clinical, laboratory, and hemodynamic parameters in portal hypertensive gastropathy: a study of 254 cirrhotics. J Clin Gastroenterol. 2010;44:294–300.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2016

Authors and Affiliations

  • Soichiro Kiyono
    • 1
  • Hitoshi Maruyama
    • 1
  • Takayuki Kondo
    • 1
  • Tadashi Sekimoto
    • 1
  • Taro Shimada
    • 1
  • Masanori Takahashi
    • 1
  • Osamu Yokosuka
    • 1
  1. 1.Department of Gastroenterology and Nephrology, Graduate School of MedicineChiba UniversityChibaJapan

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