PTU-065 Non-invasive assessment of systemic haemodynamics to determine oesophageal variceal size in cirrhotic patients: Abstract PTU-065

Abstract

Introduction Portal pressure underlies variceal development, bleeding and mortality but is not routinely assessed. Universal endoscopic screening is advised in cirrhosis with primary prophylaxis given if varices >5 mm diameter. This is labour intensive and costly, but non-invasive predictors of varices are unreliable. Cirrhosis is associated with a hyperdynamic circulation and quick, easy, non-invasive assessment of this is now possible. The aim of this study was to evaluate whether non-invasive assessment of systemic haemodynamics in cirrhosis can identify patients with significant oesophageal varices. Methods We studied 29 cirrhotic patients. Systemic haemodynamics were assessed non-invasively using the Finometer® (TNO instruments, Amsterdam), and analysed with Beatscope® software. Portal pressure was assessed by measurement of the hepatic venous pressure gradient (HVPG). Gastroscopy assessed variceal size, Japanese score and 1-year probability of bleeding according to the NIEC index. Results 69% male, median age 47 (42–55) years, Child-Pugh (CP) score 6 (Class A 18, Class B 10, Class C 1) and MELD 10 (8–13). 90% alcoholic cirrhosis, 66% abstinent. HVPG positively correlated with CP score (r=0.58, p=0.001), cardiac index (r=0.53, p=0.005) and heart rate (r=0.62, p Conclusion Non-invasive assessment of systemic haemodynamics in cirrhosis identifies the hyperdynamic circulation and can distinguish between absent/small and medium/large sized varices. This technique appears promising as a tool to help identify a group of patients who would most benefit from endoscopic screening and primary prophylaxis.