INTRAVARICEAL PRESSURE MEASUREMENT IN CIRRHOTIC-PATIENTS - IS IT A RELIABLE TECHNIQUE

The aim of the present study is to evaluate in both ''in vitro'' and c linical conditions the reliability of the method for measuring the oes ophageal varices pressure by means of a sclerosing needle. The perfusi on system was validated ''in vitro'', comparing the tracings obtained with two different perfusion apparatus, with two different perfusional agents and with the needle either completely or partially inserted in a venous catheter perfused with saline solution, either in the same d irection as the flow or the opposite one. The clinical validation was conducted on 14 cirrhotic patients with II to IV grade oesophageal var ices according to Dagradi's classification. During endoscopy, the intr avariceal and oesophageal pressures were measured using a sclerosing n eedle, perfused with hydrosoluble contrast medium. Once the intravaric eal pressure measurement was completed, an X-ray film of the chest was performed. The data were evaluated considering the absence of visible contrast medium as evidence of correct intravariceal needle position, and the presence of a roundish image as evidence of paravariceal inse rtion of the needle. The presence of respiratory oscillations and intr avariceal pressure values were verified in manometric tracings and wer e compared with radiological findings. The ''in vitro'' tests showed n o differences in the pressure recordings obtained using different pump s, different perfusion agents and with different manners of inserting the needle. Only twenty-eight of the manometric recordings were consid ered adequate for evaluation in clinical conditions. The manometric re cordings and X-ray films showed that a correct needle placement was ac hieved on seven occasions and more frequently in large rather than sma ll varices. With a correct insertion of the needle, the intravariceal pressure values appeared to be identical in the same patient. In concl usion, the sclerotherapy needle can be considered suitable for intrava riceal pressure recordings, even though it is advisable to restrict th e measurement to cases with large varices and at least two concordant manometric values should be recorded in each patient.