Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3212
Peer-review started: October 15, 2015
First decision: November 13, 2015
Revised: November 27, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: March 21, 2016
Processing time: 150 Days and 20.8 Hours
AIM: To determine the correlation between the hepatic venous pressure gradient and the endoscopic grade of esophageal varices.
METHODS: From September 2009 to March 2013, a total of 176 measurements of hepatic venous pressure gradient (HVPG) were done in 146 patients. Each transjugular HVPG was measured twice, first using an end whole catheter (EH-HVPG), and then using a balloon catheter (B-HVPG). The HVPG was compared with the endoscopic grade of esophageal varices (according to the general rules for recording endoscopic findings of esophagogastric varices), which was recorded within a month of the measurement of HVPG.
RESULTS: The study included 110 men and 36 women, with a mean age of 56.1 years (range, 43-76 years). The technical success rate of the pressure measurements was 100% and there were no complication related to the procedures. Mean HVPG was 15.3 mmHg as measured using the end hole catheter method and 16.5 mmHg as measured using the balloon catheter method. Mean HVPG (both EH-HVPG and B-HVPG) was not significantly different among patients with different characteristics, including sex and comorbid factors, except for cases with hepatocellular carcinoma (B-HVPG, P = 0.01; EH-HVPG, P = 0.02). Portal hypertension (> 12 mmHg HVPG) occurred in 66% of patients according to EH-HVPG and 83% of patients according to B-HVGP, and significantly correlated with Child’s status (B-HVPG, P < 0.000; EH-HVGP, P < 0.000) and esophageal varies observed upon endoscopy (EH-HVGP, P = 0.003; B-HVGP, P = 0.006). One hundred and thirty-five endoscopies were performed, of which 15 showed normal findings, 27 showed grade 1 endoscopic esophageal varices, 49 showed grade 2 varices, and 44 showed grade 3 varices. When comparing endoscopic esophageal variceal grades and HVPG using univariate analysis, the P value was 0.004 for EH-HVPG and 0.002 for B-HVPG.
CONCLUSION: Both EH-HVPG and B-HVPG showed a positive correlation with the endoscopic grade of esophageal varices, with B-HVPG showing a stronger correlation than EH-HVPG.
Core tip: This retrospective study aimed to determine the correlation between the hepatic venous pressure gradient (HVPG) and the endoscopic grade of esophageal varices. Our results showed a good correlation between the endoscopic grade of esophageal varices and the HVPG measured by using either end-hole catheter or balloon catheter techniques. HVPG measured with the balloon catheter method showed a stronger correlation with esophageal varix grade upon endoscopy than when measured with the end-hole catheter method. HVPG measured using the balloon catheter method provides useful information that will allow practitioners to predict the risk of esophageal varix bleeding and guide patients towards appropriate treatment.