Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2016; 22(11): 3212-3219
Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3212
Comparison of hepatic venous pressure gradient and endoscopic grading of esophageal varices
EunJi Lee, Yong Jae Kim, Dong Erk Goo, Seung Boo Yang, Hyun-Joo Kim, Jae Young Jang, Soung Won Jeong
EunJi Lee, Yong Jae Kim, Dong Erk Goo, Hyun-Joo Kim, Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea
Seung Boo Yang, Department of Radiology, Soonchunhyang University Gumi Hospital, Gyeongsangbuk-do 39371, South Korea
Jae Young Jang, Soung Won Jeong, Department of Gastroenterology, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea
Author contributions: All authors contributed equally to this work; Kim YJ, Goo DE, Yang SB, Kim HJ, Jang JY and Jeong SW collected and analyzed the data; Kim YJ and Goo DE designed and supervised the study; Lee E and Kim YJ drafted the manuscript and wrote detailed contents; Kim YJ revised the manuscript for important intellectual content; Yang SB, Kim HJ, Jang JY and Jeong SW offered the technical or material support; all authors have read and approved the final version.
Supported by the Research Program of the National Research Foundation of Korea, funded by the Ministry of Education and Science and Technology No. 2010-0011678, and the Soonchunhyang University Research Fund.
Institutional review board statement: This study was reviewed and approved by the institutional review board on Human Subjects Research and Ethics Committees of Soonchunhyang University Seoul Hospital.
Informed consent statement: Informed consent for this study was waived by the institutional review board on Human Subjects Research and Ethics Committees of Soonchunhyang University Seoul Hospital.
Conflict-of-interest statement: All authors of this study have no conflict of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yong Jae Kim, MD, Department of Radiology, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro Yongsan-gu, Seoul 04401, South Korea. rtwodtwo@schmc.ac.kr
Telephone: +82-2-7099396 Fax: +82-2-7099066
Received: October 15, 2015
Peer-review started: October 15, 2015
First decision: November 13, 2015
Revised: November 27, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: March 21, 2016
Abstract

AIM: To determine the correlation between the hepatic venous pressure gradient and the endoscopic grade of esophageal varices.

METHODS: From September 2009 to March 2013, a total of 176 measurements of hepatic venous pressure gradient (HVPG) were done in 146 patients. Each transjugular HVPG was measured twice, first using an end whole catheter (EH-HVPG), and then using a balloon catheter (B-HVPG). The HVPG was compared with the endoscopic grade of esophageal varices (according to the general rules for recording endoscopic findings of esophagogastric varices), which was recorded within a month of the measurement of HVPG.

RESULTS: The study included 110 men and 36 women, with a mean age of 56.1 years (range, 43-76 years). The technical success rate of the pressure measurements was 100% and there were no complication related to the procedures. Mean HVPG was 15.3 mmHg as measured using the end hole catheter method and 16.5 mmHg as measured using the balloon catheter method. Mean HVPG (both EH-HVPG and B-HVPG) was not significantly different among patients with different characteristics, including sex and comorbid factors, except for cases with hepatocellular carcinoma (B-HVPG, P = 0.01; EH-HVPG, P = 0.02). Portal hypertension (> 12 mmHg HVPG) occurred in 66% of patients according to EH-HVPG and 83% of patients according to B-HVGP, and significantly correlated with Child’s status (B-HVPG, P < 0.000; EH-HVGP, P < 0.000) and esophageal varies observed upon endoscopy (EH-HVGP, P = 0.003; B-HVGP, P = 0.006). One hundred and thirty-five endoscopies were performed, of which 15 showed normal findings, 27 showed grade 1 endoscopic esophageal varices, 49 showed grade 2 varices, and 44 showed grade 3 varices. When comparing endoscopic esophageal variceal grades and HVPG using univariate analysis, the P value was 0.004 for EH-HVPG and 0.002 for B-HVPG.

CONCLUSION: Both EH-HVPG and B-HVPG showed a positive correlation with the endoscopic grade of esophageal varices, with B-HVPG showing a stronger correlation than EH-HVPG.

Keywords: Hepatic venous pressure gradient, Liver cirrhosis, Esophageal varices, Endoscopic grade of esophageal varices, Balloon catheter measurement, End hole catheter measurement

Core tip: This retrospective study aimed to determine the correlation between the hepatic venous pressure gradient (HVPG) and the endoscopic grade of esophageal varices. Our results showed a good correlation between the endoscopic grade of esophageal varices and the HVPG measured by using either end-hole catheter or balloon catheter techniques. HVPG measured with the balloon catheter method showed a stronger correlation with esophageal varix grade upon endoscopy than when measured with the end-hole catheter method. HVPG measured using the balloon catheter method provides useful information that will allow practitioners to predict the risk of esophageal varix bleeding and guide patients towards appropriate treatment.