ENDOSCOPIC ULTRASONOGRAPHIC SIGNS OF PORTAL-HYPERTENSION IN CIRRHOSIS

Background: Endoscopic ultrasonography (EUS) has been suggested to inv estigate portal hypertension (PHT). We compared EUS and endoscopy in t he exploration of PHT in cirrhosis. Methods: In 58 patients with cirrh osis and 16 controls, the presence of esophageal varices and gastric v arices was recorded by both endoscopy and EUS, peridigestive varices a nd perforating veins by EUS. Relationships of patterns with each other and with clinical and biologic data were evaluated. Results: In patie nts with cirrhosis: esophageal varices were found by endoscopy and EUS in 88% and 55% of cirrhotic cases (p < 0.01), and gastric varices in 17% and 41%, respectively (p < 0.01). Perforating veins, below the gas troesophageal junction, were diagnosed by EUS in 40% of cases and neve r in controls. A significant relationship was found between perforatin g veins and the following patterns: peri-digestive varices, gastric va rices at EUS, and esophageal varices at endoscopy. In patients with an d without cirrhosis: after multivariate analysis, only esophageal vari ces at endoscopy were independently related to cirrhosis. However, in Child-Pugh class A patients, both esophageal varices and perforating v eins were independently related to cirrhosis (diagnostic accuracy, 92% ). Conclusions: EUS is of limited value in the diagnosis of cirrhosis because it gives little additional information to upper gastrointestin al endoscopy. The relationships between perforating veins, varices, an d peridigestive varices support the hypothesis that perforating veins are important in the pathogenesis of esophageal and gastric varices.