Endoscopy 2011; 43 - A24
DOI: 10.1055/s-0031-1292095

Value of endosonography for predicting risk of bleeding in cirrhotic patients with Portal Hypertensive Gastropathy

G de Stefano 1, C De Angelis 2, M de Stefano 1, A Di Sarno 1, N Farella 1, L De Luca 1, A Giorgio 1
  • 1IX Unit for Infectious Diseases and Interventional Ultrasound, D. Cotugno Hospital, Naples, Italy
  • 2Department of Gastro-Hepatology, “S. Giovanni Battista” Hospital, Turin, Italy

Aim: NIEC classification of Portal Hypertensive Gastropathy (PHG) (“mild” and “severe”) is not predictive of gastric haemorrhage. We studied the predictive value of Endosonography (EUS) for bleeding risk in patients (pts) with PHG and liver cirrhosis.

Patients and Methods: From January to December 2005, 114 consecutive pts were enrolled into the study. The inclusion criteria were: 1) diagnosis of liver cirrhosis 2) endoscopic diagnosis of PHG 3) absence of previous bleeding from upper digestive tract and/or of any endoscopic therapy 4) absence of HCC 5) absence of portal vein thrombosis. The following endosonographic findings were studied: a) presence of submucosal gastric venules (SGV) and b) presence of peri-gastric collateral veins (PGCV). The mean follow-up (FU) was 18.7+/-3.4 months (range: 12–24 months). During the FU EUS was performed every six months.

Results: The pts were grouped as follows based on endoscopic criteria: group 1 (70 pts, mild PHG) and group 2 (44 pts, severe PHG). EUS showed in group 1 SGV in 53 pts and SGV+ PGCV in 17 pts, and in group 2 SGV in 16 pts and SGV+PGCV in 28 pts. During the FU, 7 pts in Group 1 (10%) and 8 pts in Group 2 (18.2%) had gastric bleeding: the difference between mild and severe gastropathy was not statistically significant (p: n.s.)In group 1, 7/17 pts with SGV+ PGCV had chronic gastric bleeding, and in group 2, 6/28 pts with SGV+PGCV had chronic gastric bleeding and 2/28 pts had acute gastric haemorrhage. 15/45 (33.3%) pts with SGV+PGCV and none of pts with only SGV bled in the FU time (p<0.001). Eight of bleeding pts were in Child-Pugh class B of cirrhosis and seven in class C. In group 1, 15/53 pts with SGV and 10/17 with SGV+PGCV were on treatment with beta-blockers +/- nitroderivates at the enrollment in the study. The same therapy was performed in group 2 in 10/16 pts with SGV and in 19/28 pts with SGV+PGCV. All pts but two (died for cirrhosis-related complications) completed the overall follow-up. Both chronic and acute bleeding occurred in pts with evidence of SGV plus PGCV at the first EUS. The two acute haemorragic pts had severe PHG at endoscopy.

Conclusions: Endosonographic features like presence of both SGV and PGCV seem to correlate with the risk of bleeding better than the endoscopic classification.