The Predict Value Of Left Gastric Vein Flow Parameters To The Varices Degree And Bleeding Risk Of Esophageal Vein

BackgroundThe development of hepatic sclerosis and portal hypertension result in pathological and physiological change in the porto-veonous circulation.Esophageal varicosities are prone to rupture leading to hematemesis resulting in acute blood loss which may be fatal.The left gastric vein(liver gastric vein,LGV)plays a major role in the formation and development of esophageal varicosities which result from portal hypertension.Detailed anatomy of the LGV may further our understanding of the development of weak lesions in esophageal varicosities as well as aid the development of treatment strategies of this condition.Recent clinical data has shown that impending rupture of varicosities may be predicted resulting in a favorable outcome for patients.Oesophago-gastro-dudoenoscopy(OGD)may assist the clinician in identifying varicosities that are vulnerable to rupture by the presence of the “red sign” however,OGD can result in iatrogenic rupture of varicosities.A safer method of assessing varicosities is by using Color doppler ultrasound.This is a safe,non-invasive and easily available way of assessing the haemodynamic changes associated with portal hypertension.In this study we propose the use of color doppler ultrasonic observations of LGV blood flow haemodynamics with a view to identifying and predicting the degree of varicosities and their risk of rupture.Materials and MethodsWe imaged the LGV and measured the LGV venous flow index in 420 patients using TOSHIBA-6000,TOSHIBA-SSA-340 A,SIEMENS-Siena color Doppler with a view to predicting LGV rupture.Patients were divided into three groups i)bleeding group;181 patients,ii)hemorrhage group;239 patients and the iii)control group;150 patients.The results1.The LGV diameter in the hemorrhage group was greater that in bleeding and the control group and this was statistically significant(P < 0.01).2.In the hemorrhage group portal blood flow velocity was significantly slower than the other two groups pvalue.3.LGV blood flow direction of all cases in hemorrhage group is from the direction of the liver,rather than the non-hemorrhage group is only 68.6%,so it shows LGV blood flow direction should be used for prediction of esophageal vein rupture hemorrhage.The conclusion1.LGV blood vessels are thicker leading to a higher risk of esophageal vein rupture.2.Blood flow velocity within the LGV faster leading to a higher risk of esophageal vein rupture.3.The direction of blood within LGV is predictive of PV.4.Colour doppler ultrasound measurement of LGV blood is minimally invasive,accurate and easy to use in the clinical setting.