Int J Med Sci 2019; 16(12):1614-1620. doi:10.7150/ijms.37040 This issue

Research Paper

Incidence and hemodynamic feature of risky esophageal varices with lower hepatic venous pressure gradient

Hitoshi Maruyama1✉, Kazufumi Kobayashi2, Soichiro Kiyono2, Sadahisa Ogasawara2, Yoshihiko Ooka2, Eiichiro Suzuki2, Tetsuhiro Chiba2, Naoya Kato2, Yasuyuki Komiyama1, Masashi Takawa1, Hiroaki Nagamatsu1, Shuichiro Shiina1

1. Department of Gastroenterology, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan;
2. Department of Gastroenterology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.

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Maruyama H, Kobayashi K, Kiyono S, Ogasawara S, Ooka Y, Suzuki E, Chiba T, Kato N, Komiyama Y, Takawa M, Nagamatsu H, Shiina S. Incidence and hemodynamic feature of risky esophageal varices with lower hepatic venous pressure gradient. Int J Med Sci 2019; 16(12):1614-1620. doi:10.7150/ijms.37040. Available from

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Background: To examine the incidence of cirrhosis patients with high-risk esophageal varices (EV) who show hepatic venous pressure gradient (HVPG) < 10 mmHg and to identify their hemodynamic features.

Methods: This prospective study consisted of 110 cirrhosis patients with EV, all with the candidate for primary or secondary prophylaxis. Sixty-one patients had red sign, and 49 patients were bleeders. All patients underwent both Doppler ultrasound and HVPG measurement.

Results: There were 18 patients (16.4%) with HVPG < 10 mmHg. The presence of venous-venous communication (VVC) was more frequent in patients with HVPG < 10 mmHg (10/18) than in those with HVPG ≥ 10 mmHg (19/92; p = 0.0021). The flow volume in the left gastric vein (LGV) and the incidence of red sign were higher in the former (251.9 ± 150.6 mL/min; 16/18) than in the latter (181 ± 100.5 mL/min, p = 0.02; 45/92; p = 0.0018). The patients with red sign had lower HVPG (13.3 ± 4.5) but advanced LGV hemodynamics (velocity 13.2 ± 3.8 cm/s; flow volume 217.5 ± 126.6 mL/min), whereas those without red sign had higher HVPG (16.2 ± 4.6, p = 0.001) but poorer LGV hemodynamics (10.9 ± 2.3, p = 0.002; 160.1 ± 83.1, p = 0.02).

Conclusion: Patients with high-risk EV with HVPG < 10 mmHg showed 16.4% incidence. Although low HVPG may be underestimated by the presence of VVC, the increased LGV hemodynamics compensates for the severity of portal hypertension, which may contribute to the development of red sign.

Keywords: esophageal varices, ultrasound, left gastric vein, portal hemodynamics