Abstract
Background and Study Aims: Recently, details of a noninvasive balloon manometry technique for endoscopic measurement
of variceal pressure (VP) have been published. However, to date, only few data exist
on its feasibility and virtually none on its relation to endoscopic or clinical variables
of portal hypertension.
Patients and Methods: We investigated a total of 64 patients with esophageal varices using a scaled transparent
balloon and a calibrated pressure manometer. Averaged from both fivefold balloon insufflation
(variceal collapse) or desufflation (variceal appearance), we took measurements of
the VP (mmHg) using the two techniques. These measurements were correlated between
two investigators as well as to both clinical and endoscopic signs of portal hypertension.
Furthermore, pressures were assessed prospectively before and during propranolol application.
Results: Measurements were successful in > 95 % of all sessions without side effects. The
intraobserver variance was 11.0 ± 13.1 %. Measurements correlated significantly between
two observers (r = 0.80, insufflation technique, p < 0.01/r = 0.81, desufflation technique,
p < 0.01). Pressures correlated positively to variceal sizes (p < 0.05). The presence
of fundic varices was strongly associated with higher pressures (p < 0.02). In patients
without medical decompressive therapy we found a significant relationship between
VP and the presence of red colour signs or previous bleeding episodes. Clinical parameters
did not correlate with VP (p > 0.05). As assessed by this technique, 8/11 patients
receiving propranolol showed a decrease in VP (18.6 ± 19.5 % after 1.5 months and
33.3 ± 11.9 % after 3 months).
Conclusions: This noninvasive balloon technique is a safe and practical method for estimating
VP in patients with portal hypertension. As found by invasive methods, patients with
large varices and concomitant fundic varices have higher VP. A drop in intravariceal
pressure after propranolol therapy appears to be assessable.
