[Diagnosis of alcohol-induced liver cirrhosis by indirect portal vein pressure measurement and liver venography].

Indirect measurement of portal pressure and hepatic venography using the balloon catheter technique were investigated to assess the stage of chronic alcoholic liver disease, especially, to diagnose cirrhoses. 80 patients were studied and were categorised in 4 groups according to their liver histology: normal liver (N, n = 6), fibrosis (F, n = 27), incomplete cirrhosis (F/C, n = 11), complete cirrhosis (C, n = 36). Medians of wedged hepatic venous pressure gradient P (= WHVP-FHVP) and of a semiquantitative venographic score S showed increasingly higher values with more severe stages of the disease. Portal pressure (P) and venographic appearance (S) were correlated significantly (r = 0.778, p less than 0.0001). P was most useful to diagnose cirrhosis: Precirrhotic forms were associated with pressure gradients P less than or equal to 5 mm Hg in 97%. Incomplete cirrhoses were distributed in about 50% above and below P = 5 mm Hg, for complete cirrhoses P greater than or equal to 8 mm Hg was found in 97%. Pressure gradients P greater than or equal to 5 mm Hg indicated cirrhotic disease with a specificity of 97%. Sensitivity for complete cirrhoses was also high (97%), for incomplete cirrhoses however low (47%). Venography and measurement of portal pressure as diagnostic tools to predict cirrhoses of alcoholic origin were clearly more useful than biochemical tests (serum bilirubin, quick and cholinesterase). In comparison to laparoscopy the acceptance by patients is higher and the risk is lower if patients with known adverse reactions to contrast materials and risk of thyreotoxicosis induced by iodine are excluded.