Blood flow parameters in the short gastric vein and splenic vein on Doppler ultrasound reflect gastric variceal bleeding.

PURPOSE

Hemodynamic features associated with the bleeding from gastric fundal varices (FV) have not been fully examined. The purpose of this study was to elucidate hemodynamics in the short gastric vein (SGV) which is a major inflow route for FV and flow direction of the splenic vein (SV) in relation to bleeding FV.

MATERIALS AND METHODS

The subject of this retrospective study was 54 cirrhotic patients who had medium- or large-sized FV (20 bleeders, 34 non-bleeders) on endoscopy with SGV on both angiogram and sonogram. Diameter, flow velocity, flow volume of SGV and flow direction in the SV were evaluated by Doppler ultrasound.

RESULTS

Diameter, flow velocity and flow volume of SGV were significantly greater in bleeders (9.6+/-3.1 mm, 11.4+/-5.2 cm/s, 499+/-250.1 ml/min) than non-bleeders (6.5+/-2.2 mm, p=0.0141; 7.9+/-3.3 cm/s, p=0.022; 205+/-129.1 ml/min, p=0.0031). SV showed forward flow in 37 (68.5%), to and fro in 3 (5.6%) and reversed flow in 14 patients (25.9%). The frequency of FV bleeding was significantly higher in case with reversed or "to and fro" SV flow (11/17) than forward SV flow (9/37, p=0.0043). The cumulative bleeding rate at 3 and 5 years was significantly higher in patients without forward SV flow (38.8% at 3 years, 59.2% at 5 years) than in patients with forward SV flow (18.7% at 3 years, 32.2% at 5 years, p=0.0199).

CONCLUSION

Advanced SGV blood flow and reversed SV flow direction may be a hemodynamic features closely related to the FV bleeding.