Color Doppler evaluation of left gastric vein hemodynamics in cirrhosis with portal hypertension and its correlation with esophageal varices and variceal bleed

Abstract

Aim:The purpose of this study was to assess the value of Doppler evaluation of left gastric vein hemodynamics when monitoring portal hypertension patients, by correlating Doppler ultrasonography (USG) parameters with the severity of esophageal varices and occurrence of variceal bleeding.Methods:This study was carried out on 100 patients using Doppler USG and endoscopy. Forty-seven of these were patients with cirrhosis with portal hypertension, who had not had a recent variceal bleed (group 1) and 26 were patients with cirrhosis with portal hypertension, with a recent history of bleeding (group 2). The control group comprised of 27 subjects who did not have liver disease or varices on endoscopy (group 3). The hemodynamic parameters, namely the diameter of the left gastric vein and the direction and flow velocity in the vessel, were compared in these groups, with the grade of esophageal varices.Results:Hepatofugal flow velocity in the left gastric vein was higher in patients with large-sized varices compared to those patients with small-sized varices (P < 0.001). The left gastric vein hepatofugal flow velocity was higher in patients with a recent variceal bleed than in those patients without a history of a recent variceal bleed (P < 0.0149). Large-sized varices were more commonly found in patients with a history of a recent variceal bleed (P < 0.0124).Conclusion:Left gastric vein hemodynamics were found to correlate with the severity of the varices and the occurrence of recent variceal bleed in patients with cirrhosis with portal hypertension. Evaluation of the left gastric vein portal dynamics could be helpful in monitoring the progress of the disease in these patients.

Diameters of left gastric vein and its originating vein on magnetic resonance imaging in liver cirrhosis patients with hepatitis B: Association with endoscopic grades of esophageal varices

“…With the development of imaging technology, magnetic resonance (MR) portography has been described as being comparable to endoscopy for the detection of esophageal varices due to its short acquisition time, high signal‐to‐noise ratio and no radiation . It can not only visualize the anatomical distributions of the varices, but also can analyze the inflowing vein of the varices (LGV) and its originating vein which play important roles in the formation and development of the varices . Furthermore, cirrhotic patients often receive hepatocellular carcinoma surveillance with MR imaging which could be used as a “one‐stop‐shop” approach evaluating the varices at the same time without the need for a second study .…”

“…M ASSIVE HEMORRHAGE OF the upper alimentary tract resulting from esophageal varices, which are mainly supplied by an enlarged left gastric vein (LGV) originating from the splenic vein (SV) or portal vein (PV) and running to the esophagogastric junction along the lesser curvature of stomach, is a major complication of portal hypertension (PHT) secondary to liver cirrhosis. 1,2 At least two-thirds of patients with cirrhosis develop the varices, and approximately 10-60% of patients experience variceal bleeding. 1,[3][4][5] According to the criteria proposed by the Japanese Research Society for Portal Hypertension, 6 grade 2 and 3 varices have a high risk of causing life-threatening upper gastrointestinal hemorrhage.…”

“…[12][13][14][15][16] It can not only visualize the anatomical distributions of the varices, but also can analyze the inflowing vein of the varices (LGV) and its originating vein which play important roles in the formation and development of the varices. 2,[17][18][19] Furthermore, cirrhotic patients often receive hepatocellular carcinoma surveillance with MR imaging which could be used as a "onestop-shop" approach evaluating the varices at the same time without the need for a second study. 20 To our knowledge, there has been no report focusing on the utility of MR imaging to determine the association of the presence and endoscopic grades of the varices with the diameters of the inflowing vessel (LGV) and its originating vein (PV or SV).…”

Color Doppler Ultrasound in Portal Hypertension

“…The LGV may be challenging to identify in patients without signs of portal hypertension (detection rate of 70%-75%) because of its smaller caliber. [11][12][13] In cirrhotic patients, the LGV is visualized in 71% to 90% of cases with transabdominal US, depending on patients' clinical conditions and operators' experience. [12][13][14][15][16] Failure to visualize the LGV is mainly due to bowel gas artifacts and a large habitus of patients (ie, obesity).…”

Predict esophageal varices via routine trans‐abdominal ultrasound: A design of classification analysis model

“…1,2 However, less than 50% of cirrhotic patients have varices at the screening endoscopy, which implies a considerable burden for endoscopy units and an increased number of unpleasant procedures for patients. Even though researchers have evaluated many possible noninvasive markers of EV, [3][4][5][6][7] the clinical value remains controversial.…”