4586 Duplex doppler endosonography: a new gold standard for the diagnosis of portal vein thrombosis.

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Objective: to determine the feasibility, the diagnostic value and the therapeutic impact of EUS in the diagnosis of portal vein thrombosis. Subjects and methods : 71 patients , mean age 52 years (24-84 years) with portal hypertension were studied retrospectively with EUS for suspicion of portal vein thrombosis (Duplex sonography or CT). EUS was compared to the sonography (US) results, then to angiography (ACM) and to surgery (considered as gold standards). Results : In 59 US, a diagnosis was made in 55,9% of cases. In 44,1%, the diagnostic was uncertain, particularly on spleno-mesenteric confluence. In 71 EUS, achieved without mortality nor morbidity, a diagnosis was made in 97,2% with diagnostic doubt in 2,8% of cases. 49 portal thrombosis were diagnosed by EUS ( 19/49 were partial thrombosis, never specified by the ACM). In 26 cases on 49, agreement between EUS and ACM was found. In 6 cases on 49, EUS corrected the diagnosis of ACM. 17 cases on 49 had no ACM, but a surgery (liver transplantation or derivation) was only decided on EUS. It existed 2 false positive diagnosis in EUS, these two patients have been transplanted. The diagnostic value of EUS is excellent (Fisher s exact test : p < 0.01), sensitivity 100%, specificity 81,8%, positive predictive value of 94,6%, negative predictive value of 100%. Conclusion : 1) EUS is a reliable way for the diagnosis of portal vein thrombosis, higher than ACM. 2) EUS is a noninvasive exam witch have the advantage of avoiding the use of contrast agents in cirrhotic patients. 3) EUS gives a direct vision of vessels, permitting a detailed analysis (thickness of walls of the vessels, partial or nonocclusive thrombosis, flow inside the portal vein, perigastric collaterals). 4) In our experience, EUS, influenced directly the treatment, permitting a liver transplantation when the confluence was free, guiding the derivation according to the position of the thrombus or indicating a TIPS in case of partial thrombosis complicated of ascites or refractory variceal bleeding. Objective: to determine the feasibility, the diagnostic value and the therapeutic impact of EUS in the diagnosis of portal vein thrombosis. Subjects and methods : 71 patients , mean age 52 years (24-84 years) with portal hypertension were studied retrospectively with EUS for suspicion of portal vein thrombosis (Duplex sonography or CT). EUS was compared to the sonography (US) results, then to angiography (ACM) and to surgery (considered as gold standards). Results : In 59 US, a diagnosis was made in 55,9% of cases. In 44,1%, the diagnostic was uncertain, particularly on spleno-mesenteric confluence. In 71 EUS, achieved without mortality nor morbidity, a diagnosis was made in 97,2% with diagnostic doubt in 2,8% of cases. 49 portal thrombosis were diagnosed by EUS ( 19/49 were partial thrombosis, never specified by the ACM). In 26 cases on 49, agreement between EUS and ACM was found. In 6 cases on 49, EUS corrected the diagnosis of ACM. 17 cases on 49 had no ACM, but a surgery (liver transplantation or derivation) was only decided on EUS. It existed 2 false positive diagnosis in EUS, these two patients have been transplanted. The diagnostic value of EUS is excellent (Fisher s exact test : p < 0.01), sensitivity 100%, specificity 81,8%, positive predictive value of 94,6%, negative predictive value of 100%. Conclusion : 1) EUS is a reliable way for the diagnosis of portal vein thrombosis, higher than ACM. 2) EUS is a noninvasive exam witch have the advantage of avoiding the use of contrast agents in cirrhotic patients. 3) EUS gives a direct vision of vessels, permitting a detailed analysis (thickness of walls of the vessels, partial or nonocclusive thrombosis, flow inside the portal vein, perigastric collaterals). 4) In our experience, EUS, influenced directly the treatment, permitting a liver transplantation when the confluence was free, guiding the derivation according to the position of the thrombus or indicating a TIPS in case of partial thrombosis complicated of ascites or refractory variceal bleeding.