Skip to main content
SpringerLink
Log in

Evaluation of esophageal varices in liver disease by splenic-pulp manometry, splenoportography, and esophagogastroscopy

Diagnostic discrepancies

  • Published:
The American Journal of Digestive Diseases Aims and scope Submit manuscript

Summary and Conclusion

Esophagogastroscopy, splenic-pulp manometry, and splenoportography were combined in a prospective study of 60 patients with documented liver disease and suspected portal hypertension. All three procedures were performed on each of the patients within a 6-day period. Twenty patients were actively bleeding at the time of endoscopic examination.

Esophagogastroscopy demonstrated varices in 90% of the patients studied. Splenoportography, however, demonstrated collateral circulation in only 50% of the patients with endoscopically demonstrated varices. In no instance did splenoportography demonstrate collateral circulation not previously seen on endoscopy. Splenoportography failed to demonstrate collateral circulation in all patients whose splenic-pulp pressure was less than 270 mm. water.

In 20 patients with upper gastrointestinal bleeding, the height of the splenic-pulp pressure was a poor index of the site of bleeding. Eight patients with portal hypertension and esophageal varices were found to be bleeding from nonvariceal sites. Conversely, 5 patients with active bleeding from endoscopically demonstrated varices had no collateral circulation revealed by splenoportography.

It is evident from this study that splenic-pulp manometry, splenoportography, and esophagogastroscopy will frequently yield divergent results in the evaluation of portal hypertension and portosystemic collateral circulation in patients with liver disease. While splenoportography may be useful in determining the patency of the portal vein and demonstrating large spontaneous or surgical portosystemic shunts, esophagogastroscopy is a better method for detecting esophageal varices and determining whether they are bleeding. The height of the splenic-pulp pressure is of little value in indicating the site of upper gastrointestinal bleeding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. de Castro Silva, L., Goffi, F., Schmidt, L., andSao Thiago, J. B. Efficacy of esophagography, esophagoscopy, and splenoportal venography in the diagnosis of esophageal varices.Rev. paulista med. 64:10, 1964.

    Google Scholar 

  2. Jackson, F. C. “Directional” flow patterns in portal hypertension.Arch. Surg. 87:307, 1963.

    Google Scholar 

  3. Palmer, E. D. On the natural history of esophageal varices which are secondary to portal cirrhosis.Ann. Int. Med. 47:18, 1957.

    Google Scholar 

  4. Bennett, H. D., Lorentgen, C, andBauer, C. A. Transient esophageal varices in hepatic cirrhosis.Arch. Int. Med. 92:507, 1953.

    Google Scholar 

  5. Palmer, E. D. The problem of unexplainable esophageal varices.South. M. J. 56: 1317, 1963.

    Google Scholar 

  6. Evans, K. T. Oesophageal and gastric varices.Brit. J. Radiol. 32:233, 1959.

    Google Scholar 

  7. Leevy, C. M., Cherrick, G. R., andDavidson, C. S. Portal hypertension.New England J. Med. 262:397, 1960.

    Google Scholar 

  8. Panke, W. F., Moreno, A. H., andRousselot, L. M. The diagnostic study of the portal venous system.Med. Clinics North America 44:727, 1960.

    Google Scholar 

  9. Turner, M. D., Sherlock, S., andSteiner, R. E. Splenic venography and intrasplenic pressure measurement in the clinical investigation of the portal venous system.Am. J. Med. 23:846, 1957.

    Google Scholar 

  10. Zeid, S. S., Felson, B., andSchiff, L. Percutaneous splenoportal venography with additional comments on transhepatic venography.Ann. Int. Med. 52:782, 1960.

    Google Scholar 

  11. Castro, M. R. The value of splenic pulp manometry and splenoportography in the diagnosis of bleeding esophageal varices.Acta medica phillipina 19:91, 1962.

    Google Scholar 

  12. Doppman, J. L., andShapiro, R. L. Bleeding esophageal varices in presence of a normal splenoportogram.Am. J. Roentgenol. 86:1103, 1961.

    Google Scholar 

  13. Schaefer, J., Brauschireiber, J., Mistilis, S., andSchiff, L. Gastroesophageal variceal bleeding in the absence of hepatic cirrhosis or portal hypertension.Gastroenterology 46:583, 1964.

    Google Scholar 

  14. Bercstrand, I., andEkman, C. A. Percutaneous lieno portal venography.Acta radiol. 47:269, 1957.

    Google Scholar 

  15. Bergstrand, I., andEkman, C. A. Portal circulation in portal hypertension.Acta radiol. 47:1, 1957.

    Google Scholar 

  16. Palmer, E. D. On the correlation between portal venous pressure and the size and extent of esophageal varices in portal cirrhosis.Ann. Surg. 138:741, 1953.

    Google Scholar 

  17. Atkinson, M., andSherlock, S. Intrasplenic pressure as an index of portal pressure.Lancet 1:1325, 1954.

    Google Scholar 

  18. Rousselot, L. M., andBurchell, A. R. “Portal Venography and Manometry.” InDiseases of the Liver. L. Schiff, Ed. 2nd. ed., pp. 284–328. Lippincott, Philadelphia, 1963.

    Google Scholar 

  19. Katz, D., Douvres, P., Weisberg, H., Charm, R., andMcKinnon, W. Sources of bleeding in upper gastrointestinal hemorrhage: A re-evaluation.Am. J. Digest. Dis. 9:447, 1964.

    Google Scholar 

Download references

Author information

Author notes

  1. Herbert Weisberg M.D.

    Present address: U. S. Public Health Service Trainee in Gastroenterology, USA

Authors and Affiliations

  1. From the Section of Gastroenterology, Department of Medicine, New York Medical College-Metropolitan Hospital Medical Center, New York, N. Y.

    Lawrence Greene M.D., Herbert Weisberg M.D., William S. Rosenthal M.D., Peter A. Douvres M.D. & David Katz M.D.

Authors
  1. Lawrence Greene M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Herbert Weisberg M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William S. Rosenthal M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter A. Douvres M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Katz M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by Graduate Training Grant TI-AM-5237 and Clinical Research Center Grant AM-05576-02 from the National Institute of Arthritis and Metabolic Diseases, N.I.H., U. S. Public Health Service, and Contract U 1373 of the Health Research Council of the City of New York.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Greene, L., Weisberg, H., Rosenthal, W.S. et al. Evaluation of esophageal varices in liver disease by splenic-pulp manometry, splenoportography, and esophagogastroscopy. Digest Dis Sci 10, 284–292 (1965). https://doi.org/10.1007/BF02233419

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02233419

Keywords

Search

Navigation