Brensing K A, Neubrand M, Textor J, Raab P, Müller-Miny H, Scheurlen C, Görich J, Schild H, Sauerbruch T
Department of General Internal Medicine, University of Bonn, Germany.
J Hepatol. 1998 Jul;29(1):94-102. doi: 10.1016/s0168-8278(98)80183-9.
BACKGROUND/AIMS: Recently, a non-invasive endoscopic balloon technique for esophageal manometry was published. In the present study, we assess its methodological aspects together with the relationship to portal pressure.
In 20 patients with liver cirrhosis who had received an intrahepatic portosystemic stent-shunt (TIPS), we evaluated portal and variceal pressure before and after balloon occlusion of TIPS (random order). Portal pressure was measured continuously via a portal venous catheter, and variceal pressure was determined at the same time independently by two endoscopists using two balloon techniques (inflation until varix collapses; deflation until varix reappears).
Overall, mean (+/-SD) portal pressure (28.5+/-7 mmHg) was significantly higher (p<0.001) than mean variceal pressure (24.4+/-6 mmHg). Balloon manometry-determined variceal pressure values were 10+/-15% higher with the inflation technique (26.2+/-7 mmHg) than with the balloon deflation technique (22.6+/-6 mmHg, p<0.001). Portal pressure and variceal pressure correlated significantly (p<0.001; balloon inflation: r=0.61, balloon deflation: r=0.66, mean values of inflation and deflation: r=0.68). Short-term TIPS occlusion led to mean increases of 52% and 35% in portal pressure and variceal pressure, respectively. The manometry results of both endoscopists correlated well with either balloon technique (r> or =0.93; p<0.001) and we saw no adverse effects.
Variceal balloon manometry provides non-invasive variceal pressure data which correlate to portal pressure assessed prior to and after short-term TIPS occlusion. However, probably due to variance in collateral anatomy, variceal pressure does not exactly predict portal pressure and its acute changes in the individual patient. The averaged variceal pressure of the inflation and deflation balloon technique provides the best relation to portal pressure combined with a good interobserver reliability and warrants further clinical evaluation.
背景/目的：最近，一种用于食管测压的非侵入性内镜球囊技术被发表。在本研究中，我们评估其方法学方面以及与门静脉压力的关系。
在20例接受肝内门体分流支架（TIPS）的肝硬化患者中，我们评估了TIPS球囊闭塞前后的门静脉和曲张静脉压力（随机顺序）。通过门静脉导管连续测量门静脉压力，同时由两名内镜医师使用两种球囊技术独立测定曲张静脉压力（充气直至曲张静脉塌陷；放气直至曲张静脉再次出现）。
总体而言，平均（±标准差）门静脉压力（28.5±7 mmHg）显著高于平均曲张静脉压力（24.4±6 mmHg，p<0.001）。球囊测压确定的曲张静脉压力值在充气技术下（26.2±7 mmHg）比在球囊放气技术下（22.6±6 mmHg，p<0.001）高10±15%。门静脉压力和曲张静脉压力显著相关（p<0.001；球囊充气：r=0.61，球囊放气：r=0.66，充气和放气平均值：r=0.68）。短期TIPS闭塞分别导致门静脉压力和曲张静脉压力平均升高52%和35%。两名内镜医师的测压结果与两种球囊技术均具有良好的相关性（r≥0.93；p<0.001）且我们未观察到不良反应。
曲张静脉球囊测压提供了与短期TIPS闭塞前后评估的门静脉压力相关的非侵入性曲张静脉压力数据。然而，可能由于侧支循环解剖结构存在差异，曲张静脉压力并不能准确预测个体患者的门静脉压力及其急性变化。充气和放气球囊技术的平均曲张静脉压力与门静脉压力的关系最佳，同时具有良好的观察者间可靠性，值得进一步临床评估。
