Rationale and Objectives
Little is known about the hemodynamics of gastrorenal shunt (GRS), a major drainage route of gastric fundal varices (FV), in patients with FV. The aim of this study was to clarify the hemodynamic features of GRS on Doppler sonography in relation to the grading and bleeding of FV.
Materials and Methods
The study subjects consisted of 69 cirrhotic patients with FV. Diameter, flow velocity (FVe), and flow volume (FVo) of GRS were measured by Doppler ultrasound (US). The detection rate was compared to contrast-enhanced computed tomography (CECT), and percutaneous transhepatic portography (PTP) was used in six patients without GRS on CECT.
Results
The use of CECT detected GRS in 60 of 69 patients, and US, 58 of 69 patients. A false-negative result for detecting GRS on both CECT and US was found in one patient after PTP. The diameter, FVe, and FVo of GRS increased according to the endoscopic grade of FV: F1 (7.2 ± 1.3 mm, 9.8 ± 1.1 cm/s, 358.3 ± 123.4 ml/min), F2 (9.9 ± 3.3 mm, 12.8 ± 5.1 cm/s, 701.7 ± 411.3 ml/min), and F3 (11.8 ± 2.4 mm, 17.9 ± 8.3 cm/s, 1706.6 ± 989.5 ml/min). A significant difference was seen between F1 and F3 (diameter, P = .0022; FVe, P = .0133; FVo, P = .0007) and between F2 and F3 (FVe, P = .0112; FVo, P < .0001). FVe of GRS was significantly higher in bleeders (16.7 ± 8.1 cm/s) than in nonbleeders (12.2 ± 5.4 cm/s, P = .017), whereas the diameter and FVo were not significant.
Conclusion
Hemodynamics of GRS on Doppler sonograms reflected the grading and bleeding of FV. Doppler US may be valuable as a noninvasive method to evaluate the severity of FV.
Gastric fundal varices (FV) are known to be a considerable complication in patients with portal hypertension ( ). Although the rates of bleeding for FV have been reported to be lower than those for esophageal varices (EV), rupture from FV sometimes results in serious consequences in the clinical course ( ). Certain treatment methods using endoscopy, interventional techniques, and surgical procedures have been introduced for FV ( ). However, a few studies have reported risk factors for FV bleeding, and hemodynamic features associated with FV bleeding have not been clarified ( ).
There are a number of inflow vessels into FV: the left gastric, posterior gastric, and short gastric veins ( ). The main outflow pathway in the majority of FV is the gastrorenal shunt (GRS), and the blood flow manner of GRS may represent the clinical condition of FV. Watanabe et al. ( ), using the percutaneous transhepatic portography (PTP) technique, reported that the diameter of the GRS depended on the severity of FV. However, that study was based on a nonphysiologic condition using portal venous catheterization, and it lacked quantitative assessment. Little is known about the physiologic hemodynamic features of the GRS in patients with FV.
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Materials and methods
Patients
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Endoscopy
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Contrast-enhanced Computed Tomography
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Ultrasound
Equipment and settings
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Demonstration of gastrorenal shunt
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Percutaneous Transhepatic Portography
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Statistical Analysis
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Results
Comparison of the Detection Rate of Gastrorenal Shunt Between Ultrasound and Contrast-enhanced Computed Tomography
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Hemodynamic Features of Gastrorenal Shunt on the Sonograms
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![Figure 3, Color Doppler (72-year-old man with medium-grade gastric fundal varices [F2]). The sagittal plane of the color Doppler sonogram showed gastrorenal shunt with a to-and-fro appearance.](https://storage.googleapis.com/dl.dentistrykey.com/clinical/HemodynamicFeaturesofGastrorenalShunt/2_1s20S1076633208001839.jpg)
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Table 1
Hemodynamics in the Gastrorenal Shunt (GRS) in Relation to the Grade of Gastric Fundal Varices
FV GRS (mean ± SD) Diameter (mm) FVe (cm/s) FVo (mL/m) F1 7.2 ± 1.3 ⁎ 9.8 ± 1.1 ‡ 358.3 ± 123.4 ⁎⁎ F2 9.9 ± 3.3 † 12.8 ± 5.1 § 701.7 ± 411.3 †† F3 11.8 ± 2.4 ⁎ † 17.9 ± 8.3 ‡ § 1706.6 ± 989.5 ⁎⁎ ††
FVe: flow velocity; FVo: flow volume.
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Table 2
Hemodynamics in the Gastrorenal Shunt (GRS) in Relation to the Bleeding of Gastric Fundal Varices
GRS (mean ± SD) Diameter (mm) FVe (cm/s) FVo (mL/m) Nonbleeder 10.2 ± 3.5 ⁎ 12.2 ± 5.4 † 843.8 ± 810.3 ‡ Bleeder 10.3 ± 2.5 ⁎ 16.7 ± 8.1 † 1187.1 ± 914.2 ‡
FVe: flow velocity; FVo: flow volume.
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Discussion
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Conclusion
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