Surgery Today

, Volume 27, Issue 3, pp 197–201 | Cite as

The significance of esophageal variceal pressure in patients with cirrhosis

  • Takanori Yoshida
  • Toshio Bandoh
  • Seigo Kitano
  • Koichiro Shuto
  • Koichi Ninomiya
  • Yoshinobu Mitarai
  • Michio Kobayashi
Original Articles
  • 22 Downloads

Abstract

We measured the portal circulatory hemodynamic parameters in 10 cirrhotic patients with portal hypertension and esophageal varices to determine the significance of esophageal variceal pressure. In 4 patients (group I), the temporary portal vein occlusion produced significant elevations in both the esophageal variceal pressure and the portal venous pressure. The results of the portal circulatory hemodynamic assessment in this group were consistent with the predominance of the backward flow mechanism. In the remaining 6 patients (group 11), however, portal vein clamping resulted in a slightly increased esophageal variceal pressure with an enormous increase in the portal pressure. The forward flow mechanism thus appeared to be predominant in group II. In other words, the results of the pressure measurements were consistent with the functional separation of the hemodynamics in the esophageal varices and portal trunk in group 11 and the functional hemodynamic continuity in group I. This functional separation between the esophageal varices and the portal trunk in group II might therefore have resulted from the increased blood flow in the lesser splanchnic region.

Key Words

portal hypertension portal vein clamping backward flow mechanism forward flow mechanism 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bandoh T, Mitarai Y, Kitano S, Yoshida T, Kobayashi M (1994) Clinical significance of esophageal variceal pressure in patients with esophageal varices. J Hepatol 21:326–331Google Scholar
  2. 2.
    Rigau J, Bosch J, Bordas JM, Navasa M, Mastai R, Kravetz D, Bruix J, Fen F, Rodes J (1989) Endoscopic measurement of variceal pressure in cirrhosis: Correlation with portal pressure and variceal hemorrhage. Gastroenterology 96:873–880Google Scholar
  3. 3.
    Gertsch P, Bohnet J, Mosimann R (1983) Endoscopic nonaggressive assessment of oesophageal variceal pressure compared with wedged hepatic venous pressure in alcoholic liver cirrhosis. Endoscopy 15:101–103Google Scholar
  4. 4.
    Dawson J, Gertsch P, Mosimann R, West R, Elias E (1985) Endoscopic variceal pressure measurements: Response to isosorbide dinitrate. Gut 26:843–847Google Scholar
  5. 5.
    Sarin SK, Sethi KK, Nanda R (1987) Measurement and correlation of wedged hepatic, intrahepatic, intrasplenic and intravariceal pressures in patients with cirrhosis of liver and non-cirrhotic portal fibrosis. Gut 28:260–266Google Scholar
  6. 6.
    Japanese Research Society for Portal Hypertension (1992) The general rules for recording endoscopic findings on esophagogastric varices (1991) (in Japanese). Acta Hepatol Jpn 33:277–281Google Scholar
  7. 7.
    Inokuchi K, Beppu K, Koyanagi N, Nagamine K, Hashizume M, Iwanage T, Sugimachi K (1984) Fifteen years' experience with left gastric venous caval shunt for esophageal varices. World J Surg 8:716–721Google Scholar
  8. 8.
    Mitarai Y, Kobayashi M, Yoshida T, Kim YI (1989) Changes in gastric mucosal blood flow after surgical therapy for oesophageal varices. J Gastroenterol Hepatol [Suppl] 1:85–87Google Scholar
  9. 9.
    Yoshida T, Mitarai Y, Kobayashi M (1990) Role of glucagon in gastric hyperdynamic circulation of cirrhotic portal hypertension (in Japanese with English abstract). Nippon Shokakigeka Gakkai Zasshi (Jpn J Gastroenterol Surg) 23:1830–1837Google Scholar
  10. 10.
    Koyanagi N, Inokuchi K, Nakayama S, Sakata H, Beppu K (1981) Decreased arteriovenous flow resistance in the left gastric venous area in cirrhotic patients. Fur J Clin Invest 11:355–359Google Scholar
  11. 11.
    Vorobioff J, Bredfeldt JE, Groszmann RJ (1984) Increased blood flow through the portal system in cirrhotic rats. Gastroenterology 87:1120–1126Google Scholar
  12. 12.
    Benoit JN, Womack WA, Hernandez L, Granger DN (1985) “Forward” and “backward” flow mechanisms of portal hypertension. Relative contributions in the rat model of portal vein stenosis. Gastroenterology 89:1092–1096Google Scholar
  13. 13.
    Aoki H, Hasumi A, Shimazu M (1988) The hemodynamics of esophago-gastric varices: Significance of esophago-gastric arterial inflow in their formation. In: Idezuki Y (ed) Treatment of esophageal varices. Elsevier, Amsterdam, pp 315–328Google Scholar
  14. 14.
    Futagawa S, Nakanishi R, Nishimura Y, Sugiura M (1988) Angiographic study of hemodynamics in portal hypertension. In: Idezuki Y (ed) Treatment of esophageal varices. Elsevier, Amsterdam, pp 355–359Google Scholar
  15. 15.
    Bosch J, Bordas JM, Rigau J, Viola C, Mastai R, Kravetz D, Navasa M, Rodes J (1986) Noninvasive measurement of the pressure of esophageal varices using an endoscopic gauge: Comparison with measurements by variceal puncture in patients undergoing endoscopic sclerotherapy. Hepatology 6:667–672Google Scholar
  16. 16.
    Polio J, Groszmann RJ (1986) Hemodynamic factors involved in the development and rupture of esophageal varices: A pathophysiologic approach to treatment. Semin Liver Dis 6:318–331Google Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • Takanori Yoshida
    • 1
  • Toshio Bandoh
    • 1
  • Seigo Kitano
    • 1
  • Koichiro Shuto
    • 1
  • Koichi Ninomiya
    • 1
  • Yoshinobu Mitarai
    • 1
  • Michio Kobayashi
    • 1
  1. 1.First Department of SurgeryOita Medical UniversityHasama, OitaJapan

Personalised recommendations