VARICEAL AND PORTAL PRESSURE MEASUREMENT - TECHNIQUES AND APPLICATIONS

Variceal and portal pressure measurements are currently the most widel y used invasive techniques for the haemodynamic evaluation of portal h ypertension in cirrhotic patients. Variceal pressure can be measured d uring endoscopy either directly by variceal puncture or indirectly by using a pressure sensitive gauge. More recently, an indirect technique which uses a plastic balloon attached to the end of the endoscope has been described. Variceal pressure appears to be an important risk fac tor for the occurrence of variceal haemorrhage as most studies conclud ed that variceal pressure tends to be higher in patients with previous bleeding than those without. Hepatic venous catheterization with meas urements of the wedged and free hepatic pressures has become the metho d of choice in the estimation of portal pressure as it is a simple, fa st and safe procedure, less invasive and more reproducible than the ot her techniques. Information obtained from hepatic vein catheterization gives a significant prognostic value in predicting survival. Despite the lack of a linear relationship between portal pressure and risk of variceal bleeding most prospective studies have concluded that the hei ght of portal pressure is an important and independent predictive fact or for bleeding. Hepatic venous catheterization is currently the best method of assessing the haemodynamic response to drug treatment and pr ediction of therapeutic response for the prevention of bleeding.