Gut Liver.  2013 Nov;7(6):704-711.

The Risk Factors for Bleeding of Fundal Varices in Patients with Liver Cirrhosis

• Park EJ
• Jang JY
• Lee JE
• Jeong SW
• Lee SH
• Kim SG
• Cha SW
• Kim YS
• Cho YD
• Cho JY
• Kim HS
• Kim BS
• Kim YJ

Abstract

BACKGROUND/AIMS
The relationship between portal hemodynamics and fundal varices has not been well documented. The purpose of this study was to understand the pathophysiology of fundal varices and to investigate bleeding risk factors related to the presence of spontaneous portosystemic shunts, and to examine the hepatic venous pressure gradient (HVPG) between fundal varices and other varices.
METHODS
In total, 85 patients with cirrhosis who underwent HVPG and gastroscopic examination between July 2009 and March 2011 were included in this study. The interrelationship between HVPG and the types of varices or the presence of spontaneous portosystemic shunts was studied.
RESULTS
There was no significant difference in the HVPG between fundal varices (n=12) and esophageal varices and gastroesophageal varices type 1 (GOV1) groups (n=73) (17.1+/-7.7 mm Hg vs 19.7+/-5.3 mm Hg). Additionally, there was no significant difference in the HVPG between varices with spontaneous portosystemic shunts (n=28) and varices without these shunts (n=57) (18.3+/-5.8 mm Hg vs 17.0+/-8.1 mm Hg). Spontaneous portosystemic shunts increased in fundal varices compared with esophageal varices and GOV1 (8/12 patients [66.7%] vs 20/73 patients [27.4%]; p=0.016).
CONCLUSIONS
Fundal varices had a high prevalence of spontaneous portosystemic shunts compared with other varices. However, the portal pressure in fundal varices was not different from the pressure in esophageal varices and GOV1.

Keyword

Cirrhosis; Hypertension, portal; Hepatic venous pressure gradient; Fundal varices; Portasystemic shunt, surgical

MeSH Terms

Adult
Aged
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices/etiology/*physiopathology
Esophagus
Female
Gastric Fundus
Gastrointestinal Hemorrhage/etiology/*physiopathology
Humans
Hypertension, Portal/complications/*physiopathology
Liver Cirrhosis/complications/*physiopathology
Male
Middle Aged
*Portal Pressure
*Renal Veins
Risk Factors
*Splenic Vein
Stomach/*blood supply
Vascular Fistula/complications/*physiopathology