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Distinctive portal venographic pattern in patients with sclerotherapy resistant oesophageal varices
Author(s) -
TOYONAGA ATSUSHI,
IWAO TADASHI,
SUMINO MICHIHIRO,
TAKAGI KOHSUKE,
OHO KAZUHIKO,
SHIGEMORI HIROYUKI,
TANIKAWA KYUICHI
Publication year - 1996
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/j.1440-1746.1996.tb01837.x
Subject(s) - sclerotherapy , varices , medicine , gastric varices , portal hypertension , varix , portal venous pressure , portosystemic shunt , esophageal varices , radiology , gastroenterology , cirrhosis
We performed prophylactic sclerotherapy in 350 patients with ‘high risk’ oesophageal varices (F2 or F3 with a moderate or severe red colour sign). Of these patients, eight exhibited sclerotherapy resistance (i.e. no significant reduction in the size of varices after five sessions of sclerotherapy). Thus, the prevalence of sclerotherapy resistant varices was 2%. Of 350 patients, 97 underwent haemodynamic investigation before sclerotherapy. This group consisted of seven patients with sclerotherapy resistant varices and 90 patients with non‐resistant varices. Portal pressure, assessed by portal venous pressure gradient, was similar in these two groups (21.5±4.8 vs 19.8±5.0 mmHg, respectively; NS). However, the prevalence of the ‘pipe‐line’ form of variceal feeding pattern (a large dilated left gastric vein running up the oesophagus) was higher in patients with resistant varices than in those with non‐resistant varices (100 vs 3%, respectively; P <0.01) and the diameter of the left gastric vein was larger in patients with resistant varices than in those with non‐resistant varices (12.4±2.0 vs 7.8±2.3 mm, respectively; P <0.01). Moreover, the extravariceal portosystemic shunt was poorly developed in patients with resistant varices compared with non‐resistant varices (0 vs 52%, respectively; P <0.05). We conclude that the pipe‐line pattern, fed by a large left gastric vein and associated with poorly developed extravariceal portosystemic shunt, is a distinctive portal venographic feature of sclerotherapy resistant varices.