Abstract
In 91 patients with fundic gastric varices, we analyzed a relationship between variceal bleeding and portal hemodynamics. Portal pressure in 25 bleeders who underwent percutaneous transhepatic portography was 318 mmH2O (mean) and it was significantly higher than that in 12 non-bleeders (p < 0.05). Feeding veins to fundic gastric varices were located near the splenic hilum in 60% of the patients. Blood flow velocity in the feeding vein to fundic gastric varices in 18 bleeders who underwent Doppler US was higher than that in 29 non-bleeders (p = 0.053). In 32.3% of 31 bleeders, reversed flow was observed in the splenic vein, and the incidence was significantly higher than that in 40 non-bleeders (p < 0.05). A cumulative bleeding rate in patients with reversed flow in the splenic vein was higher than that in patients with forward flow (p < 0.05). These results suggest that evaluation of hemodynamic state in the varices is useful to decide the indication of prophylactic treatment of fundic gastric varices.
