The Change of Portal Hemodynamics before and after Transjugular Intrahepatic Portosystemic Shunt according to Variceal Type: Gastric and Esophageal varix

Purpose: To investigate the changes occurring in portal hemodynamics in patients with esophageal and gastric varices, according to variceal type, before and after TIPS. Materials and Methods: Between January 1994 and June 1999, we evaluated 22 of 44 patients who had undergone TIPS and endoscopy on admission. In these 22, hepatic venous and main portal venous pressure were measured. On the basis of endoscpic findings, the esophageal and gastric varices were classified as one of three types. Changes in portal hemodynamics in relation to the diameter of the portal vein, mean portosystemic gradient before and after TIPS, MPSG, and the presence of hepatic encephalopathy and gastrorenal shunt were all evaluated. Results: Endoscopy indicated that there were ten Type-I cases, nine Type-II, and three Type-III. The diameter of the main portal vein was 14.95 1.79 mm in Type I cases, and 13.35 1.59 mm in Type II. Before TIPS, main portal venous pressure was 31.40 6.79 mmHg (Type I) and 22.80 4.26 mmHg (Type II), and the mean portosystemic gradient was 16.10 7.0 mmHg (Type I), and 11.20 5.36 mmHg (Type II). After TIPS, the pres-sure readings were 25.70 7.60 mmHg (Type I) and 17.80 6.52 mmHg (Type II), while those relating to were 10.80 4.94 mmHg (Type I) and 5.25 3.67 mmHg (Type II). MPSG was 6.04 2.98 mmHg (Type I) and 5.91 3.98 mmHg (Type II). Angiography revealed that the gastrorenal shunt was Type I in 10% of cases, Type II in 77%, and Type III in 33%. Hepatic encephalopathy after TIPS occured in three Type-I cases, three-Type- II, and two Type-III. Conclusion: The diameter of the main portal vein was significantly smaller, and portal venous pressure and mean portosystemic gradient before and after TIPS significantly lower in patients with dominant gastric varices than in those with dominant esophageal varices (p