Characterization Of Esophageal Gastric Varices In Portal Hypertension Patients With Spontaneous Shunts

OBJECTIVE:Portal hypertension is a common complication in patients with cirrhosis.When portal pressure exceeds a certain threshold,the blood stream will bypass portal vein and get through its branches to the branches of the inferior and superior vena cava,forming of collateral route reflux circulation,and resulting in formation of varicose veins.In some patients with portal hypertension,in addition to the common gastric and esophageal varices,spontaneous gastric-kidney bypass and spleen-kidney bypass were formed to reduce portal pressure.Spontaneous shunt is not very common in clinical practice,which was often seen in severe portal hypertension,especially when portal pressure exceeds 10mmHg.In the circumstances,severe complications will occur,such as hepatic encephalopathy,gastrointestinal bledding,and leading to increase of endoscopic injection sclerotherapy(EIS)treatment-induced ectopic embolism and thrombosis after liver transplantation.This study is to investigate the charcateristics of patients with portal vein shunt and endoscopic features of esophageal varices.METHODS:Data of patients who were hospitalized to Department of Gastroenterology,First Affiliated Hospital of Zhejiang University School of Medicine from January 2012 to August 2015,and data of patients who were hospitalized to Infectious Diseases from January 2014 to August 2015 were collected,finally a total of 118 patients were enrolled in this study,97 cases were male and 21 were females,mean age was 55.16 ±10.05 years.108 patients had history of gastrointestinal bleeding,39cases had splenectomy,39 cases had history of endoscopic treatment,11 cases had hepatocellular carcinoma,a number of clinical parameters(including blood,bilirubin,albumin,transaminase,serum ammonia,coagulation routine,renal function,etc.)were tested,Child-Pugh score was calculated,Child A grade 80 cases,Child B grade 32 cases,Child C grade 5 cases.All patients underwent portal vein CTA examination and gastroscopy.RESULTS:Through the portal CTA examination,the spleen-kidney or stomach-kidneyshunt was found in 24 cases,94 patients had no shunt.Mean portal vein diameter of patients with 12.48 ± 2.79mm,mean portal vein diameter of patients without shunt was 13.58 ± 3.46mm,no statistically significant difference was detected(P value of 0.154).Mean varices area of patients with shunt was 294.00(0.00-2400.00)mm2,significantly greater than patients without shunt 26.00(0.00-1620.00)mm2)(P value less than 0.001).Esophageal varices scope and severity were significantly different between patients with shunts and patients without shunt.Regardless of history of gastrointestinal bleeding,shunts group have larger gastric varices area than in no-shunt group;in patients without endoscopic treatment,shunts group have larger gastric varices area than no-shunt group;patients who had no splenectomy,shunts group gastric vein area shunt group was significantly greater than no-shunts group,mean portal vein diameter in shunt group was significantly smaller than in no-shunt group;in patients with Child A grade and B grade,shunt group have larger gastric varices area than in no-shunt group.CONCLUSION:Spontaneously portal hypertension shunt can reduce portal pressure to some extent,the patients with spontaneous shunt who did not receive splenectomy have a lower portal pressure and smaller portal vein diameter,and all patients with shunt have lesser degree of esophageal varices,while patients with spontaneous shunt have larger gastric twisted varicose veins.