Recently it has been recommended that all cirrhotic patients without previuos variceal haemorrhage unergo endoscopic screening to dectect varices and that thos with large varices should be treated with B blockers (American College of Gastroenterology). Using color Doppler velocity profile (CDVP), investigation of vascular haemodynamics and thier relationship with esophageal varices (EV) presence and bleeding in patients with liver cirrhosis can be achieved. Methods: The haemodynamics of the portal vien (PV), [PV diameter, mean velocity, flow value and congestion index], splenic artery (pulsatility and resistive indices) and hepatic vien waveforms were evaluated in 65 cirrhotic patients and 10 with no chronic liver disease as control volunteers. Esophogastrodoudenoscopic evaluation was performed to all subjects. The haemodynamic features were compared between variceal patients without a history of esophageal variceal bleeding (EVB), those with a history of EVB and those with no vaices. A logestic regression model was employed to identify factors associated with EVB and the occurrence of varices. Results: Compared with the size of EV, patients with grade B and C Child-Pugh scores are at risk of having enlaged varices than grade A. The cirrhotic group has a significantly lower mean portal vien flow volume (P less than 0.001), a significantly elevtaed mean portal vein congestion index (P less than 0.001) and diameter (P less than 0.05) compared with the controls. In the EV individuals, there was a higher incidence of low PV velocity (P less than 0.05) and high congestion index than those without varices. Resistive index of the splenic artery was significatly higher in group with EVB than those without (P less than 0.001). Logestic regresion analysis revealed that, PV congestion index and splenic artery resistive index are independent esophageal variceal presence and bleeding (respectively) related factors. Conclusion: Increased resistive index of splenic artery may be a sensitive predictor of variceal bleeding. Portal vien congestion index and flow volume are also statistically significant factors for EV prediction. |
