D. Kravetz et al., TOTAL VOLUME PARACENTESIS DECREASES VARICEAL PRESSURE, SIZE, AND VARICEAL WALL TENSION IN CIRRHOTIC-PATIENTS, Hepatology, 25(1), 1997, pp. 59-62
It has been suggested that ascites is a risk factor for variceal bleed
ing in cirrhotic patients. However, no data of total volume paracentes
is (TVP) effects on variceal hemodynamics has yet been published, The
aim of this study was to investigate the effects of TVP on variceal pr
essure, size, and tension in cirrhotic patients, Before sclerotherapy,
18 cirrhotic patients with grade II esophageal varices were studied,
The following measurements were performed on 12 patients at basal cond
ition and after TVP: inferior vena cava pressure, esophageal pressure
(EP), and intravariceal pressure (IVP) by direct punction and variceal
size at endoscopy, The same measurements were performed at basal cond
ition and 1 hour later without TVP on the other 6 patients used as a c
ontrol group. Variceal pressure gradient (VPG) and variceal wall tensi
on (WT) were calculated, Paracentesis and intra-abdominal pressure wer
e obtained with a direct punction, No demographic differences were obs
erved between both groups, Paracentesis produced a significant reducti
on of IVP (from 25.6 +/- 2.4 to 17.9 +/- 2.1 mm Hg, means +/- SEM, -30
%, P < .05), VPG (from 16.6 +/- 2.4 to 10.8 +/- 1.4 mm Hg, -35%, P < .
05), TVP also reduced variceal size (from 9 +/- 0.3 to 5.6 +/- 0.4 mm,
-38%, P < .05) and WT (from 75.3 +/- 11.6 to 30 +/- 4.7 mm Hg, mm, -6
0%, P < .05), Intra-abdominal pressure decreased from 18 +/- 2.2 to 4
+/- 0.9 mm Hg (P < .05), and IVC decreased from 15.5 +/- 2.4 to 5.7 +/
- 1.5 mm Hg (P < .05), No significant differences were observed in mea
n arterial pressure and heart rate. The mean ascitic fluid removed was
8 +/- 0.71 L, No significant difference between measurements was obse
rved in the control group, Our results show that TVP significantly dec
reases variceal pressure and tension, These results suggest that ascit
es removal can be useful in the treatment of variceal bleeding in cirr
hotic patients.