PORTAL SHUNTING IN INFERIOR MESENTERIC VEIN IN CIRRHOSIS - CORRELATION WITH HEMORRHAGE FROM ESOPHAGEAL-VARICES

Objective: Certain patients with portal hypertension develop large eso phageal varices, whereas others have small varices, or none. Our objec tive in this study was to determine whether this variability depends u pon the amount of blood derived by peripheral portosystemic collateral s. Methods: Esophagogastroscopy to determine presence and size of esop hageal varices, and perrectal portal scintigraphy to assess portosyste mic shunt index (PSI) in inferior mesenteric vein were performed in 45 cirrhotics and 17 patients with precirrhotic liver disease. Results: Patients with cirrhosis had higher PSI than normal controls (67 +/- 4 vs. 8 +/- 2%; p < 0.0001) and precirrhotic patients (vs. 34 +/- 6%; p < 0.0001). Neither variceal size nor PSI was correlated with Child-Pug h classification or hepatic venous pressure gradient. PSI was not rela ted to the presence of varices or their size. On the other hand, patie nts with variceal hemorrhage had elevated PSI, compared with nonbleede rs (80 +/- 4% vs. 59 +/- 6%; p < 0.005). Conclusions: This study shows that portosystemic collaterals in the inferior mesenteric vein do not prevent the formation of large varices. Furthermore, the magnitude of blood flow through peripheral collaterals might reflect the risk of v ariceal hemorrhage.