SEQUENTIAL VARICEAL PRESSURE MEASUREMENT BY ENDOSCOPIC NEEDLE PUNCTURE DURING MAINTENANCE SCLEROTHERAPY - THE CORRELATION BETWEEN VARICEAL PRESSURE AND VARICEAL REBLEEDING

Background/Aims: The risk factors for esophageal variceal rebleeding a re little known, Variceal pressure is one of the major determinants of variceal rupture, but the relationship between variceal pressure and variceal rebleeding during maintenance sclerotherapy has not been dete rmined. This study was undertaken to evaluate the relationship between variceal pressure/gradient change and variceal rebleeding during main tenance sclerotherapy, Methods: Patients with liver cirrhosis and rece nt esophageal variceal hemorrhage underwent consecutive variceal press ure measurements by direct puncture of the varices before each electiv e sclerotherapy, Results: In 46 patients, the initial variceal pressur e was no different regardless of age, sex, underlying etiology or hepa tic reserve, Variceal pressure was higher in large varices, varices wi th more severe red male markings, and varices with slower reduction in size during maintenance sclerotherapy. A larger volume of sclerosant was required to eradicate large varices, varices with more severe red male markings, and varices with slower reduction in size during mainte nance sclerotherapy, There was a positive correlation between initial variceal pressure and total amount of sclerosant (r=0.485, p=0.001), I nitial variceal pressure was not related to rebleeding, Variceal press ure increased more in patients with rebleeding from varices per se (n= 7) than in those without rebleeding (n=24). There was no difference in pressure change between patients without rebleeding (n=24) and those with rebleeding from variceal ulcers (n=7),Conclusions: Large varices, severe red color signs and slow reduction in variceal size were assoc iated with higher initial variceal pressure, and more sclerosant was r equired to eradicate the varices, An increase in variceal pressure dur ing maintenance sclerotherapy indicates a higher risk of variceal rebl eeding, but not of variceal ulcer rebleeding.