Measurement of variceal pressure with an endoscopic pressure sensitive gauge: validation and effect of propranolol therapy in chronic conditions

Nevens, Frederik; Sprengers, D.; Feu, Faust; Bosch, Jaime; Fevery, Johan

doi:10.1016/s0168-8278(96)80188-7

Cited by 48 publications

(25 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…31 In this study, variceal pressure was measured using a noninvasive technique developed in our laboratory that has been validated in other centers also. [15][16][17]32 This technique, however, has some limitations. The first and more important is that it is not feasible in every patient.…”

Section: Discussionmentioning

confidence: 99%

“…7,9 The transmural pressure at the varices can be assessed noninvasively at endoscopy using a pressure-sensitive endoscopic gauge developed in our laboratory that has been shown to allow accurate, reproducible measurements of variceal pressure. [9][10][11][12][13][14][15][16][17] Previous studies indicated that the technique allows assessment of the acute and chronic effects of drug therapy on portal hypertension. 11-15 Moreover, there is evidence suggesting that measurements of variceal pressure may have prognostic value in Abbreviations: TIPS, transjugular intrahepatic portosystemic shunt; HVPG, hepatic venous pressure gradient; WHVP, wedged hepatic venous pressure; FHVP, free hepatic venous pressure; CI, confidence interval; ROC, receiver operating characteristic curve; NIEC, North Italian Endoscopic Club index.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2000

View full text Add to dashboard Cite

Noninvasive measurements of variceal pressure adequately reflect the hemodynamic effects of propranolol on portal hypertension. However, the prognostic value of variceal pressure responses during continued propranolol therapy has not been evaluated, and it is unclear whether this may substitute invasive measurements of portal pressure response. Fifty-five portal hypertensive patients with cirrhosis were studied before and at 4 months of continued propranolol therapy. Variceal pressure was measured using an endoscopic pressure gauge. Portal pressure was evaluated as the hepatic venous pressure gradient (HVPG). Over a 28 ؎ 11 month follow-up, 16 patients experienced variceal bleeding. Baseline characteristics were similar in bleeders and nonbleeders. At 4 months, reduction in variceal pressure was less marked in bleeders than in nonbleeders (5% ؎ 20% vs. ؊15% ؎ 24%; P ‫؍‬ .03). A fall in variceal pressure 20% or greater of baseline was an independent predictor of absence of variceal bleeding; which occurred in 5% of patients with a 20% or greater fall in variceal pressure versus 42% of patients with less than a 20% reduction (P ‫؍‬ .004). The HVPG response had similar independent prognostic value (decrease H20%: 6% bleeding; decrease F20%: 45% bleeding; P ‫؍‬ .004) but identified different patients. Achieving a 20% decrease in either variceal pressure or HVPG was highly sensitive (85%) and specific ( Variceal bleeding is the most frequent and severe complication of portal hypertension in patients with cirrhosis. 1 Several treatment options are available to prevent recurrent variceal bleeding, including pharmacological therapy, endoscopic banding ligation, and surgical or transjugular intrahepatic portosystemic shunts (TIPS). 1,2 It has been recently shown that pharmacological treatment with propranolol offers almost optimal protection from bleeding and rebleeding when the portal venous pressure (estimated by the hepatic venous pressure gradient [HVPG]), achieves a target reduction. 3,4 The risk of bleeding or rebleeding is virtually abolished when the HVPG decreases to 12 mm Hg or below, 3-5 and the actuarial risk of rebleeding at 2 years is only 9% when the HVPG is reduced by at least 20% of the baseline value. 4 This has been thereafter confirmed by other studies, 6 emphasizing the concept that pharmacological treatment represents the optimal therapy in the subgroup of patients achieving such a pronounced decrease in HVPG. [1][2][3][4] Unfortunately, there is no adequate noninvasive way of assessing the HVPG response to treatment, which calls for repeated invasive hemodynamic studies.Several endoscopic findings, such as the size of the varices and the presence of red color signs (which are thought to reflect a reduced thickness of variceal wall) show a significant correlation with the risk of bleeding. 1,7,8 These are some of the main determinants of variceal wall tension, 7 which is believed to play a key role in determining variceal rupture. 7,9 According to Laplace' s law, variceal wall tension is directly re...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2000

View full text Add to dashboard Cite

show abstract

“…In addition, the majority of patients had varices larger than 5 mm-a size at which VP measurement can be performed with maximum accuracy, 14 but which is also associated with a higher bleeding risk-and 38% of the patients had a decompensated liver disease. Because drug therapy such as propranolol 13 and spironolactone 20 affects VP, and thus probably the bleeding risk, only patients on a constant medical therapy, taken for at least 1 month, were included in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Measurements of VP were performed at endoscopy by using a previously described pressure-sensitive gauge (Varipress, Labotron, Barcelona, Spain). [11][12][13][14] All patients received premedication with 2.5 to 7.5 mg diazepam and 40 mg n-butylscopolamine IV. The Varipress method uses a small hemispheric pressure gauge attached to the distal end of an endoscope.…”

Section: Methodsmentioning

confidence: 99%

“…9,10 The use of a pressure-sensitive endoscopic gauge allows for measurements of variceal pressure (VP) in a noninvasive, easy, and accurate way. 11 Some initial cross-sectional studies 12,13 have documented a higher VP in variceal bleeders than in nonbleeders. However, the possible relationship between VP and the risk of bleeding needed more extensive study and confirmation.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Variceal pressure is a factor predicting the risk of a first variceal bleeding: A prospective cohort study in cirrhotic patients

Nevens¹,

Bustami²,

Scheys³

et al. 1998

Hepatology

Self Cite

114

View full text Add to dashboard Cite

Predictive criteria for a first variceal hemorrhage lack substantial accuracy. Cross-sectional studies suggest a close relationship between variceal pressure (VP) and the occurrence of variceal bleeding. In the present prospective cohort study, the significance of VP measurement for prediction of a first variceal bleed was assessed. Eighty-seven patients with cirrhosis and large esophageal varices who had never developed variceal bleeding were followed for 12 months. The endpoint of the study was the presentation or not of a variceal hemorrhage. Thirty-four patients (39%) were in Child's class A, 37 in class B (43%), and 16 in class C (18%). The median interval between endoscopic diagnosis of varices and the beginning of the study was 15 months. Twenty-eight patients (32%) developed a variceal hemorrhage with a bleeding-related mortality of 18% (n‫.)5؍‬ The 1-year mortality overall was 16% (n‫.)41؍‬ Variables predictive of a first bleed identified by Cox proportional hazards regression model were: the level of VP, the North Italian Endoscopic Club (NIEC) score, and the interval between the diagnosis of varices and the start of the study. By adding VP to NIEC, a significant gain in prognostic accuracy was obtained (P ‫؍‬ .003). In conclusion, the present study provides evidence that the level of VP is a major predictive factor for variceal hemorrhage, and that it provides further prognostic information in addition to the NIEC index. (HEPATOLOGY 1998;27:15-19.)

show abstract

Primary prevention of variceal bleeding in people with oesophageal varices due to liver cirrhosis: a network meta-analysis

Roccarina

Best

Freeman

et al. 2021

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

show abstract

Measurement of variceal pressure with an endoscopic pressure sensitive gauge: validation and effect of propranolol therapy in chronic conditions

Cited by 48 publications

References 23 publications

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

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

Variceal pressure is a factor predicting the risk of a first variceal bleeding: A prospective cohort study in cirrhotic patients

Primary prevention of variceal bleeding in people with oesophageal varices due to liver cirrhosis: a network meta-analysis

Contact Info

Product

Resources

About