Measurement of variceal pressure and its clinical implications

Recent investigations show that variceal pressure (VP) is more closely related to the risk of variceal bleeding than is the hepatic venous pressure gradient. As a consequence, the measurement and follow-up of VP is receiving more attention.

Variceal pressure can be measured by the fine needle puncture technique. A close correlation with intrasplenic pressure recording and a high reproducibility in chronic conditions with this technique were confirmed in our laboratory. Using this technique, we recently demonstrated that an intravenous bolus injection of somatostatin 250 micrograms or 500 micrograms given together with a slow infusion of 250 micrograms/h yielded a rapid and transient decrease in VP. Our experience with the non-invasive pressure sensitive gauge shows that the procedure is easy to perform, well standardized and that it has a high reproducibility in acute conditions.

We inferred from our study of the acute effect of somatostatin that, in the event somatostatin is used in the treatment of variceal haemorrhage, repeated bolus injection should be included to arrest the bleeding. The high accuracy of non-invasive VP measurements suggests that this technique may have an application in the follow-up of patients with oesophageal varices.