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Intérêt de l’échoendoscopie dans la prise en charge des complications hémorragiques de l’hypertension portale

Value of endoscopic ultrasonography in the management of haemorrhagic complications of portal hypertension

  • Published:
Acta Endoscopica

Résumé

L’hémorragie par rupture de VO, complication fréquente responsable de 30 % de décès à la phase aiguë, est reliée à l’augmentation de la pression portale, la taille des varices et l’insuffisance hépatique. En l’absence de critères hémodynamiques fiables et facilement reproductibles, l’échoendoscopie va permettre une étude globale à la fois anatomique et hémodynamique du système porte et des veines de dérivation. Ces nouveaux éléments vont aider à sélectionner des patients à haut risque de saignement variqueux et adapter au mieux la prévention de l’hémorragie. L’EES va rechercher des facteurs prédictifs de mauvaise réponse aux traitements habituels et évaluer les possibilités de la mise en place d’un TIPS. Le traitement par ponction écho-guidée ou écho-assistée des varices profondes et en particulier des grosses veines pénétrantes est techniquement réalisable mais reste encore à évaluer.

Summary

Haemorrhage by rupture of OV is a frequent complication responsible for 30% of mortality in the acute phase. It is linked to the increase of portal pressure, the size of the varices and the hepatic insufficiency. In the absence of accurate and easily reproducible hemodynamic criteria, endoscopic ultrasonography allows for a global anatomic and hemodynamic study of the portal system and of the collateral veins. These new elements will help to select patients with high risk of variceal bleeding and to adapt the best strategy for preventing haemorrhage. EUS will be able to find the predictive factors of bad response to the usual treatments and to assess the possibilities to create a TIPS. The treatment by ultrasonographically guided or ultrasonographically assisted puncture of deep varices and mainly of penetrating large veins is technically possible but still needs to be assessed.

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Abbreviations

HTP:

Hypertension portale

EES:

échoendoscopie

GVPH:

Gradient veineux porto-sushépatique

VP, VO, VG:

Veine porte, varices œsophagiennes, varices gastriques

PHT:

Portal hypertension

EUS:

Endoscopic Ultrasonography

VPHG:

Veinous portos sushepatic gradient

PV, OV, GV:

Portal vein, oesophageal veins, gastric veins

Références

  1. Huet PM, Pomier-Layrargues G. The hepatic venous pressure gradient: Remixed and revisited. Hepatology 2004; 39: 295–8.

    Article  PubMed  Google Scholar 

  2. Vanbiervliet G, Pomier-Layrargues G, Huet PM. Diagnostic invasif de l’hypertention portale au cours des hépatopathies chroniques. Gastroenterol Clin Biol 2005; 29: 975–87.

    Google Scholar 

  3. Taourel P, Blanc P, Dauzat M, Chabre M, Pradel J, Gallix B, Larrey D, Bruel JM. Doppler study of mesenteric, hepatic, and portal circulation in alcoholic cirrhosis: relationship between quantitative Doppler measurements and the severity of portal hypertension and hepatic failure. Hepatology 1998; 28: 932–6.

    Article  PubMed  CAS  Google Scholar 

  4. Dib A, Konate G, Oberti F, Cales P. Diagnostic non invasif de l’hypertension portale au cours de la cirrhose. Gastroentérol Clin Biol 2005; 29: 975–87.

    Article  PubMed  Google Scholar 

  5. Spahr L, Giostra E, Morard I, Mentha G, Hadengue A. Perendoscopic variceal pressure measurement: a reliable estimation of portal pressure in cirrhotic patients. Gastroenterol Clin Biol 2006; 30: 1012–8.

    Article  PubMed  Google Scholar 

  6. Caletti GC, Brocchi E, Ferrari A, Fiorino S, Barbara L. Value of endoscopic ultrasonography in the management of portal hypertension. Endoscopy 1992; 24: 342–6.

    Article  PubMed  Google Scholar 

  7. Boustière C, Dumas O, Jouffre C, Letard JC, Patouillard B, Etaix JP, Barthélémy C, Audigier JC. Endoscopic ultrasonography classification of gastric varices in patients with cirrhosis. Comparison with endoscopic findings. J Hepatol 1993; 19: 68–72.

    Article  Google Scholar 

  8. Letard JC, Boustière C, Jouffre C, Barthélémy C, Veyret C, Audigier JC. Reversal of portal blood flow in cirrhosis. Clinical, endoscopic and ultrasound endoscopic correlations in 72 patients. Gastroenterol Clin Biol 1993; 17: 578–83.

    PubMed  CAS  Google Scholar 

  9. Lee YT, Chan FK, Ching JY, Lai CW, Leung VK, Chung SC, Sung JJ. Diagnosis of gastroesophageal varices and portal collateral venous abnormalities by endosonography in cirrhotic patients. Endoscopy 2002; 34: 391–8.

    Article  PubMed  CAS  Google Scholar 

  10. Burtin P, Cales P, Oberti F, Joundy N, Person B, Carpentier S, Boyer J. Endoscopic ultrasonographic signs of portal hypertension in cirrhosis. Gastrointest Endosc 1996; 44(3): 257–61.

    Article  PubMed  CAS  Google Scholar 

  11. Lee YT, Sung JJ, Yung MY, Yu AL, Chung SC. Use of color Doppler EUS in assessing azygos blood flow for patients with portal hypertension. Gastroinest Endosc 1999; 50: 47–52.

    Article  CAS  Google Scholar 

  12. Leung VK, Sung JJ, Ahuja AT, Tumala IE, Lee YT, Lau JY, Chung SC. Large paraesophageal varices on endosonography predict recurrence of esophageal varices and rebleeding. Gastroenterology 1997; 112: 1811–6.

    Article  PubMed  CAS  Google Scholar 

  13. Sato T, Yamazaki K, Toyota J, Karino Y, Ohmura T, Akaike J, Kuwata Y, Suga T. Perforating veins in recurrent esophageal varices evaluated by endoscopic color Doppler ultrasonography with a galactose-based contrast agent. J Gastroenterol 2004; 39: 422–8.

    Article  PubMed  Google Scholar 

  14. Castellani P, Carrere C, Debono E, Constant T, Giovannini M, Le Treut YP et al. Duplex Doppler endosonography: a new “gold standard” for the diagnosis of portal vein thrombosis. Gastrointestinal Endoscopy 2000; 51: 45–55.

    Article  Google Scholar 

  15. Irisawa A, Saito A, Obara K, Shibukawa G, Takagi T, Shishido H, Sakamoto H, Sato Y, Kasukawa R. Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities: severe periesophageal collateral veins and large perforating veins. Gastrointest Endosc 2001; 53: 77–84.

    Article  PubMed  CAS  Google Scholar 

  16. Schiano TD, Adrain AL, Vega KJ, Liu JB, Black M, Miller LS. High-resolution endoluminal sonography assessment of the hematocystic spots of esophageal varices. Gastrointest Endosc 1999; 49: 424–7.

    Article  PubMed  CAS  Google Scholar 

  17. Konishi Y, Nakamura T, Kida H, Seno H, Okazaki K, Chiba T. Catheter US probe in EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence. Gastrointest Endosc 2002; 55: 197–203.

    Article  PubMed  Google Scholar 

  18. Castellani P, Moulin G, Bartoli JM, Constant T, Debono E, Bernardini D et al. Interest of colour doppler EUS in transjugular intrahepatic portosystemic shunt (TIPS) survey. Hepatology 1998; 28: 658–62.

    Google Scholar 

  19. Lahoti S, Catalano MF, Alcocer E, Hogan WJ, Geenen JE. Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler. Gastrointest Endoscopy 2000; 51: 331–3.

    Article  CAS  Google Scholar 

  20. Andrade de Paulo G, Ardengh JC, Nakao FS, Ferrari AP. Treatment of esophageal varices: a randomized controlled trial comparing endoscopic sclerotherapy and EUS-guided sclerotherapy of esophageal collateral veins. Gastrointestinal Endoscopy 2006; 63: 396–402.

    Article  Google Scholar 

  21. Nishida H, Giostra E, Spahr L, Mentha G, Mitamura K, Hadengue A. Validation of color Doppler EUS for azygos blood flow measurement in patients with cirrhosis: application to the acute hemodynamic effects of somatostatin, octreotide, or placebo. Gastrointest Endosc 2001; 54: 24–30.

    Article  PubMed  CAS  Google Scholar 

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Author notes

  1. Ch. Boustière

    Present address: Service d’hépato-Gastroentérologie, Hôpital Saint Joseph, Bd de Louvain, 13825, Marseille, France

Authors and Affiliations

  1. Service d’hépato-Gastroentérologie, Hôpital Saint Joseph, Bd de Louvain, 13825, Marseille, France

    P. Castellani

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  1. Ch. Boustière
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  2. P. Castellani
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Boustière, C., Castellani, P. Intérêt de l’échoendoscopie dans la prise en charge des complications hémorragiques de l’hypertension portale. Acta Endosc 37, 7–14 (2007). https://doi.org/10.1007/BF02961812

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  • DOI: https://doi.org/10.1007/BF02961812

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