PORTAL VENOUS FLOW PATTERN AS A PREDICTOR OF BLEEDING FROM ESOPHAGEAL VARICES IN CIRRHOTIC

Aim of the work: to evaluate whether (1) the portal venous flow pattern determined by color Doppler sonography could be related to the clinical severity of liver cirrhosis and (2) whether the flow patterns differ between patients with bleeding and nonbleeding oesophageal varices. Subjects and methods: 60 cirrhotic patients and 30 noncirrhotic healthy controls were enrolled after endoscopic survey for the presence of oesophageal varices. Each patient received color Doppler echography to define the pattern of blood flow direction as hepatopetal or nonhepatopetal (hepatofugal, turbulence, and bidirection) in type. The patients with oesophageal varices were further categorized into two groups: with recent bleeding (BOV; n = 30) and without recent bleeding (NBOV; n = 30). Results: More patients in the BOV group (76.7%) had a nonhepatopetal Doppler flowpattern than in the control group (0%) and NBOV group (30%) (P < 0.001). Among the BOV group, the nonhepatopetal flow pattern of the portal vein was higher in 46.7% of Child–Pugh grade C patients than in 0% of grade A patients and 23.3% of grade B patients (P < 0.001). Among the NBOV group, the nonhepatopetal flow pattern of the portal vein was higher in 23.3% of Child–Pugh grade C patients than in 0% of grade A patients and 6.7% of grade B patients (P = 0.001). Conclusions: Portal venous blood flow pattern is related to severity of cirrhosis. The presence of a nonhepatopetal flowpattern implicates an increased risk of oesophageal varices bleeding, especially for those cirrhotic patients with Child–Pugh grades B and C.