A new device for measuring esophageal variceal pressure

Miller, Elan; Kim, Joseph K.; Gandehok, Jasneet; Hara, Mak; Dai, Qing; Malik, Aslam; Miller, Aaron L.; Miller, Larry S.

doi:10.1016/s0016-5107(02)70195-8

Cited by 22 publications

(4 citation statements)

References 12 publications

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“…The presence of the former is a strong indicator of a future occurrence of a re-bleed[ 50 , 51 ]. Intravariceal pressure can also be recorded in animal models by Miller et al [ 52 ] using a non-invasive EUS-based 20-MHz ultrasound transducer in a latex balloon catheter sheath.…”

Section: Eus-guided Management Of Variceal Bleedmentioning

confidence: 99%

Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

Dhar¹,

Samanta²

2023

World J Gastrointest Endosc

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Endoscopic ultrasound (EUS) has expanded its arena from a mere diagnostic modality to an essential therapeutic tool in managing gastrointestinal (GI) diseases. The proximity of the GI tract to the vascular structures in the mediastinum and the abdomen has facilitated the growth of EUS in the field of vascular interventions. EUS provides important clinical and anatomical information related to the vessels' size, appearance and location. Its excellent spatial resolution, use of colour doppler with or without contrast enhancement and ability to provide images “real-time” helps in precision while intervening vascular structures. Additionally, structures such as venous collaterals or varices can be dealt with optimally using EUS. EUS-guided vascular therapy with coil and glue combination has revolutionized the management of portal hypertension. It also helps to avoid radiation exposure in addition to being minimally invasive. These advantages have led EUS to become an upcoming modality to complement traditional interventional radiology in the field of vascular interventions. EUS-guided portal vein (PV) access and therapy is a new kid on the block. EUS-guided portal pressure gradient measurement, injecting chemotherapy in PV and intrahepatic portosystemic shunt has expanded the horizons of endo-hepatology. Lastly, EUS has also forayed into cardiac interventions allowing pericardial fluid aspiration and tumour biopsy with experimental data on access to valvular apparatus. Herein, we provide a comprehensive review of the expanding paradigm of EUS-guided vascular interventions in GI bleeding, portal vein access and its related therapeutic interventions, cardiac access, and therapy. A synopsis of all the technical details involving each procedure and the available data has been tabulated, and the future trends in this area have been highlighted.

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Section: Eus-guided Management Of Variceal Bleedmentioning

confidence: 99%

Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

Dhar¹,

Samanta²

2023

World J Gastrointest Endosc

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“…Jackson et al used HRES to measure variceal wall thickness and radius, and performed direct needle puncture to measure the in− travariceal pressure in patients with portal hypertension [47]. To avoid risk of variceal bleeding from needle puncture, Miller et al have reported success in developing a noninvasive EUS−based device to measure intravariceal pressure in a varix model by placing a 20−MHz ultrasound transducer in a latex balloon cath− eter sheath and attaching the catheter to a pressure transducer [48,49]. This assembly was then placed in a notched overtube of special design and placed through a biopsy channel of a ther− apeutic endoscope and tested on variceal models made of nitro− cellulose dialysis tubes of various lengths and filled with water.…”

Section: Eus Measurement Of Esophageal Variceal Tensionmentioning

confidence: 99%

EUS for portal hypertension: a comprehensive and critical appraisal of clinical and experimental indications

Elsaadany¹,

Jalil²,

Irisawa³

et al. 2008

Endoscopy

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Endoscopic ultrasonography (EUS) has significantly improved our understanding of the complex vascular structural changes that occur in portal hypertension and their clinical and prognostic significance. EUS in combination with color Doppler technique enables us to study the hemodynamic changes in the portal venous system noninvasively, and to determine objectively the effect of different pharmacological agents on portal hypertension. EUS has also found some role in the treatment and follow up of esophageal and gastric varices. It may play a clinical role in the diagnosis of gastric, duodenal, and rectal varices. Recently reported EUS-based devices that measure variceal wall tension and intravariceal pressure noninvasively could have an impact on the identification of patients at high risk of variceal bleeding with the aim of initiating prophylactic treatment, and in the assessment of patients' responses to drug therapy of portal hypertension. EUS is occasionally very helpful in the clinical management of portal hypertension. It is an interesting and important research tool for many experimental indications that are not routinely applied in clinical practice at this time.

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“…Intravariceal pressure is another predictive factor for the risk of variceal bleeding. A new noninvasive method of measuring intravariceal pressure has been introduced by Miller et al [2]. The device was constructed by placing a 20 MHz ultrasound transducer in a latex balloon catheter attached to a pressure transducer.…”

Section: Endoscopic Prediction Of Variceal Hemorrhagementioning

confidence: 99%

Variceal Bleeding and Portal Hypertension: Has There Been Any Progress in the Last 12 Months?

Seewald

Mendoza²,

Seitz³

et al. 2003

Endoscopy

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A review of the literature on the management of esophagogastric varices published in the last 12 months shows that the data are still quite conflicting. In the primary and secondary prophylaxis of variceal bleeding, beta-blockers are still the mainstay of pharmacotherapy. Measurement of the hepatic portal venous pressure gradient is considered to be a reliable parameter for successful reduction of portal pressure using medical therapy. However, intolerance of propranolol requiring discontinuation of therapy has been observed in approximately 30 % of patients. Patients' compliance with medication may represent another drawback of medical therapy. The role of endoscopic band ligation in secondary prophylaxis is now indisputable, especially in comparison with sclerotherapy. In the primary prevention of variceal bleeding, band ligation is beginning to have a competitive edge over pharmacological therapy. Acute variceal bleeding is no longer a frequent morbid emergency. Most cases of bleeding can now be managed successfully with band ligation and N-butyl-2-cyanoacrylate obliteration. N-butyl-2-cyanoacrylate has come into increasingly widespread use in the treatment of bleeding gastric fundal varices in which surgery or transjugular intrahepatic portosystemic shunting were previously regarded as the preferred therapies.

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A new device for measuring esophageal variceal pressure

Cited by 22 publications

References 12 publications

Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

Endoscopic ultrasound-guided vascular interventions: An expanding paradigm

EUS for portal hypertension: a comprehensive and critical appraisal of clinical and experimental indications

Variceal Bleeding and Portal Hypertension: Has There Been Any Progress in the Last 12 Months?

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