Title: Role of Hepatic Venous Pressure Gradient as a predictor of response to Endoscopic Variceal Ligation in patients of Cirrhosis with Esophageal varices
Authors: Gul Javid, Ghulam Mohd Gulzar, Shoib Mohd Patto, Mohd Sultan Alie, Showkat Ali Zargar
DOI: http://dx.doi.org/10.18535/jmscr/v3i9.28
Background: Portal hypertension is a major consequence of cirrhosis characterized by life threatening variceal bleeding. Estimation of Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing portal hypertension. Advances in endoscopic treatment have improved survival rates. Objective: Assessment of HVPG as a predictor of response to endoscopic variceal ligation (EVL) in patients of cirrhosis with esophageal varices. Material and Methods: HVPG was measured in 40 consecutive cirrhotic patients, 26 had history of variceal bleeding, 27 were males and mean age was 51.05±9.99 years. All patients received EVL until variceal eradication. Results: Ten patients had HVPG ≤ 12 mmHg, 11 patients had 13 -15 mmHg, 10 patients had 16-18 mmHg and 9 patients had > 18 mmHg. . Mean number of EVL sessions required for variceal eradication in patients with HVPG ≤ 12, 13-15, 16-18 and >18 mmHg were 2.10, 2.64, 4.10, 5.33 respectively. A significantly positive correlation was found between the levels of HVPG and number of EVL sessions required for variceal eradication (correlation coefficient of 0.844, regression coefficient of 0.344). Patients requiring more number of EVL sessions had significantly (p<0.001) higher mean HVPG levels ascompared to patients requiring less number of EVL sessions. Post hoc analysis on pair wise comparison shows that as HVPG rises, there is significant increase (p<0.001) in number of EVL sessions required for variceal eradication. Conclusion: HVPG has a significant influence on response to EVL, in terms of number of sessions required for variceal eradication. Key Words: Cirrhosis, portal hypertension, HVPG, Varices, EVL, Variceal obliteration. 1. Boyer TD, Triger DR, Horisawa M, Redeker AG, Reynolds TB. Direct transhepatic measurement of portal vein pressure using a thin needle. Comparison with wedged hepatic vein pressure. Gastroenterology 1977: 72:584 –589. 2. 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