DISTINCTIVE PORTAL VENOGRAPHIC PATTERN IN PATIENTS WITH SCLEROTHERAPYRESISTANT ESOPHAGEAL-VARICES

We performed prophylactic sclerotherapy in 350 patients with 'high ris k' oesophageal varices (F2 or F3 with a moderate or severe red colour sign). Of these patients, eight exhibited sclerotherapy resistance (i. e. no significant reduction in the size of varices after five sessions of sclerotherapy). Thus, the prevalence of sclerotherapy resistant va rices was 2%. Of 350 patients, 97 underwent haemodynamic investigation before sclerotherapy. This group consisted of seven patients with scl erotherapy resistant varices and 90 patients with non-resistant varice s. Portal pressure, assessed by portal venous pressure gradient, was s imilar in these two groups (21.5 +/- 4.8 vs 19.8 +/- 5.0 mmHg, respect ively; NS). However, the prevalence of the 'pipe-line' form of varicea l feeding pattern (a large dilated left gastric vein running up the oe sophagus) was higher in patients with resistant varices than in those with non-resistant varices (100 vs 3%, respectively; P<0.01) and the d iameter of the left gastric vein was larger in patients with resistant varices than in those with non-resistant varices (12.4 +/- 2.0 vs 7.8 +/- 2.3 mm, respectively; P<0.01). Moreover, the extravariceal portos ystemic shunt was poorly developed in patients with resistant varices compared with non-resistant varices (0 vs 52%, respectively; P<0.05). We conclude that the pipe-line pattern, fed by a large left gastric ve in and associated with poorly developed extravariceal portosystemic sh unt, is a distinctive portal venographic feature of sclerotherapy resi stant varices.