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Evaluation morphologique de l’hypertension portale dans la cirrhose : confrontation laparoscopie œso-gastroduodénoscopie et corrélation avec la pression sinusoïdale corrigée

Morphologic evaluation of portal hypertension in liver cirrhosis : confrontation laparoscopy - upper G.I. endoscopy and correlation with corrected sinusoidal pressure

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Acta Endoscopica

RéSUMé

L’incidence des signes d’hypertension portale (H.T.P.) à la laparoscopie et à l’œsogastroduodénoscopie (O.G.D.) a été étudiée chez 269 patients cirrhotiques.

Aucun signe endoscopique d’H.T.P. n’a été observé chez 85 (31 %) malades. Une circulation collatérale intra-abdominale et des varices œsophagiennes (V.O.) étaient présentes chez respectivement 153 (57 %) et 145 (53 %) malades.

Il existe une corrélation hautement significative entre la présence d’une circulation collatérale intra-abdominale et la présence de V.O. (p < 0,0005). Cependant 12 % des cirrhotiques sans signe d’H.T.P. à la laparoscopie sont porteurs de V.O., hémorragiques dans 1/3 cas. De même la corrélation entre la présence d’ascite, et celle de V.O. est tout aussi significative (p < 0,0005). Cependant ni la présence d’ascite, ni celle d’une circulation collatérale intra-abdominale ne permettent de préjuger de la taille des V.O.

Respectivement 44 et 31 % des cirrhotiques étaient porteurs de lésions associées du tractus digestif supérieur selon qu’ils présentaient ou non des signes d’H.T.P. (laparoscopie et/ou O.G.D.). Il s’agissait principalement de lésions associées éroso-exulcératives superficielles qui sont significativement plus fréquentes chez les patients présentant des signes d’H.T.P. (p < 0,025).

La pression sinusoïdale corrigée est significativement plus élevée chez les patients présentant une circulation collatérale intra-abdominale (p < 0,02) ou une ascite (p < 0,01). Bien que la laparoscopie apporte des renseignements complémentaires utiles dans le bilan d’une H.T.P., l’O.G.D. reste un examen indispensable chez tout malade cirrhotique pour rechercher et préciser la taille des V.O. et dépister toute lésion éventuellement associée.

Summary

The relationship between laparoscopic and upper G. I. features of portal hypertension (P. H. T.) has been studied in 269 cirrhotic patients. No features of P.H. T. was observed in 31 %. Intraabdominal collateralization was present in 153 (57 %) and esophageal varices in 145 (53 %).

There is a significant correlation between the presence of intra- abdominal collateral vessels and the presence of varices (p < 0,0005). However 12 % of cirrhotic patients without intra- abdominal collateralization presented esophageal varices, bleeding in 113 cases. Likewise a similar significant correlation was found between the presence of ascites and the presence of varices (p < 0,0005). But neither the presence of ascites nor the presence of intra- abdominal collateralization allow to anticipate the size of the esophageal varices.

According to the presence or absence of P.H. T. features (at laparoscopy and/or upper G.I. endoscopy) 44 % and 31 % of patients presented associated upper G. I. lesions, mainly erosive and exulcerative ones. These were significantly more frequent when P. H. T. features were present (p < 0,0025).

Portohepatic gradient, assessed by corrected sinusoidal pressure was significantly higher in patients with intra- abdominal collateral vessels (p < 0,02) or with ascites (p < 0,01).

Whatever the value of laparoscopy in assessing the portal collateral circulation, the usefulness of upper G.I. endoscopy in cirrhotic patients must be emphasized for searching and grading esophageal varices and screening for associated lesions.

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Authors and Affiliations

  1. Département de Gastroentérologie et Service de radiologie, Hôpital Universitaire Brugmann, Bruxelles, Belgique

    A. Burette, M. de Reuck, M. van Gossum, N. Dumont, C. Jonas & M. Deltenre

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  1. A. Burette
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  2. M. de Reuck
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  3. M. van Gossum
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  4. N. Dumont
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  5. C. Jonas
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  6. M. Deltenre
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Burette, A., Reuck, M.d., Gossum, M.v. et al. Evaluation morphologique de l’hypertension portale dans la cirrhose : confrontation laparoscopie œso-gastroduodénoscopie et corrélation avec la pression sinusoïdale corrigée. Acta Endosc 15, 131–138 (1985). https://doi.org/10.1007/BF02962655

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