Scheurlen C, Roleff A, Neubrand M, Sauerbruch T
Department of General Internal Medicine, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany.
Endoscopy. 1998 May;30(4):326-32. doi: 10.1055/s-2007-1001277.
Recently, details of a noninvasive balloon manometry technique for endoscopic measurement of variceal pressure (VP) have been published. However, to date, only few data exist on its feasibility and virtually none on its relation to endoscopic or clinical variables of portal hypertension.
We investigated a total of 64 patients with esophageal varices using a scaled transparent balloon and a calibrated pressure manometer. Averaged from both fivefold balloon insufflation (variceal collapse) or desufflation (variceal appearance), we took measurements of the VP (mmHg) using the two techniques. These measurements were correlated between two investigators as well as to both clinical and endoscopic signs of portal hypertension. Furthermore, pressures were assessed prospectively before and during propranolol application.
Measurements were successful in > 95% of all sessions without side effects. The intraobserver variance was 11.0 +/- 13.1%. Measurements correlated significantly between two observers (r = 0.80, insufflation technique, p < 0.01/r = 0.81, desufflation technique, p < 0.01). Pressures correlated positively to variceal sizes (p < 0.05). The presence of fundic varices was strongly associated with higher pressures (p < 0.02). In patients without medical decompressive therapy we found a significant relationship between VP and the presence of red colour signs or previous bleeding episodes. Clinical parameters did not correlate with VP (p > 0.05). As assessed by this technique, 8/11 patients receiving propranolol showed a decrease in VP (18.6 +/- 19.5% after 1.5 months and 33.3 +/- 11.9% after 3 months).
This noninvasive balloon technique is a safe and practical method for estimating VP in patients with portal hypertension. As found by invasive methods, patients with large varices and concomitant fundic varices have higher VP. A drop in intravariceal pressure after propranolol therapy appears to be assessable.
最近，一种用于内镜测量静脉曲张压力（VP）的无创球囊测压技术的细节已被公布。然而，迄今为止，关于其可行性的数据很少，而关于其与门静脉高压的内镜或临床变量之间关系的数据几乎没有。
我们使用一个刻度透明球囊和一个校准压力计对总共64例食管静脉曲张患者进行了研究。从五次球囊充气（静脉曲张塌陷）或放气（静脉曲张出现）中平均取值，我们使用这两种技术测量了VP（毫米汞柱）。这些测量值在两名研究人员之间进行了相关性分析，同时也与门静脉高压的临床和内镜征象进行了相关性分析。此外，在普萘洛尔应用之前和期间对压力进行了前瞻性评估。
在所有操作中，测量成功率超过95%，且无副作用。观察者内方差为11.0±13.1%。两名观察者之间的测量值具有显著相关性（充气技术，r = 0.80，p < 0.01/放气技术，r = 0.81，p < 0.01）。压力与静脉曲张大小呈正相关（p < 0.05）。胃底静脉曲张的存在与较高压力密切相关（p < 0.02）。在未接受药物减压治疗的患者中，我们发现VP与红色征的存在或既往出血事件之间存在显著关系。临床参数与VP无相关性（p > 0.05）。通过该技术评估，11例接受普萘洛尔治疗的患者中有8例VP下降（1.5个月后下降18.6±19.5%，3个月后下降33.3±11.9%）。
这种无创球囊技术是评估门静脉高压患者VP的一种安全实用的方法。正如通过有创方法所发现的，患有大静脉曲张和伴有胃底静脉曲张的患者VP较高。普萘洛尔治疗后静脉曲张内压力的下降似乎是可以评估的。
