Total volume paracentesis decreases variceal pressure, size, and variceal wall tension in cirrhotic patients

Abstract

the development of variceal bleeding, 4-6 the effects of TVP It has been suggested that ascites is a risk factor for on splanchnic hemodynamics has acquired a new interest. variceal bleeding in cirrhotic patients. However, no data Several studies have demonstrated that total paracentesis 1 of total volume paracentesis (TVP) effects on variceal or implantation of a peritoneovenous shunt 7,8 results in a hemodynamics has yet been published. The aim of this significant decrease of free and wedge hepatic venous presstudy was to investigate the effects of TVP on variceal sures without modifications in the hepatic venous pressure pressure, size, and tension in cirrhotic patients. Before gradient, a change that arises from the reduction of intrasclerotherapy, 18 cirrhotic patients with grade II esophabdominal pressure. 1,4,5 However, Luca et al. 9 recently demageal varices were studied. The following measurements onstrated that TVP in cirrhotic patients with tense ascites were performed on 12 patients at basal condition and could favorably influence hepatic hemodynamics by causing after TVP: inferior vena cava pressure, esophageal presa significant decrease in wedge hepatic venous pressure and sure (EP), and intravariceal pressure (IVP) by direct hepatic venous pressure gradient, in addition to a marked punction and variceal size at endoscopy. The same meadecrease in portocollateral blood flow as estimated by azygos surements were performed at basal condition and 1 hour blood flow determination. If these changes are confirmed, it later without TVP on the other 6 patients used as a conwould add an important hemodynamic effect to the overall trol group. Variceal pressure gradient (VPG) and variconsequences of TVP. If TVP decreases variceal blood flow, ceal wall tension (WT) were calculated. Paracentesis and a reduction in variceal pressure could ensue, an effect that intra-abdominal pressure were obtained with a direct could justify its use for the treatment of variceal hemorrhage punction. No demographic differences were observed in patients with cirrhosis and ascites. However, the complex between both groups. Paracentesis produced a signifirelation between portal and portocollateral hemodynamics cant reduction of IVP (from 25.6 { 2.4 to 17.9 { 2.1 mm does not assure that changes in flow are always followed Hg, means { SEM, 030%, P õ .05), VPG (from 16.6 { 2. 4 by changes in pressure. 10 We therefore designed the present to 10.8 { 1.4 mm Hg, 035%, P õ .05). TVP also reduced study to investigate the effects of TVP on variceal pressure, variceal size (from 9 { 0.3 to 5.6 { 0.4 mm, 038%, P õ size, and tension in cirrhotic patients with tense ascites. .05) and WT (from 75.3 { 11.6 to 30 { 4.7 mm Hg. mm, 060%, P õ .05). Intra-abdominal pressure decreased PATIENTS AND METHODS from 18 { 2.2 to 4 { 0.9 mm Hg (P õ .05), and IVC de-The study was performed from September 1993 to March 1995 on creased from 15.5 { 2.4 to 5.7 { 1.5 mm Hg (P õ .05). No 18 cirrhotic patients admitted to our Liver Unit. The diagnosis of significant diff...

Predictive value of the variceal pressure response to continued pharmacological therapy in patients with cirrhosis and portal hypertension

“…Our current results indicate that if used carefully by gastroenterologists familiar with the technique and its limitations, the method may provide a new way of monitoring the response to pharmacological therapy for portal hypertension. It is likely, but not certain, that these results might be extrapolated to other methods for the measurement of variceal pressure, such as the direct puncture of the varices 10,11,33 and the endoscopic balloon technique. 34,35 However, the former carries some risk of inducing complications, which makes it inadequate for repeated use in patients not undergoing injection sclerotherapy, and the latter is still experimental 34 and relies on the visual appearance of the varices, which is subject to observer bias.…”