Total volume paracentesis decreases variceal pressure, size, and variceal wall tension in cirrhotic patients

Abstract

It has been suggested that ascites is a risk factor for variceal bleeding in cirrhotic patients. However, no data of total volume paracentesis (TVP) effects on variceal hemodynamics has yet been published. The aim of this study was to investigate the effects of TVP on variceal pressure, size, and tension in cirrhotic patients. Before sclerotherapy, 18 cirrhotic patients with grade II esophageal varices were studied. The following measurements were performed on 12 patients at basal condition and after TVP: inferior vena cava pressure, esophageal pressure (EP), and intravariceal pressure (IVP) by direct punction and variceal size at endoscopy. The same measurements were performed at basal condition and 1 hour later without TVP on the other 6 patients used as a control group. Variceal pressure gradient (VPG) and variceal wall tension (WT) were calculated. Paracentesis and intra- abdominal pressure were obtained with a direct punction. No demographic differences were observed between both groups. Paracentesis produced a significant reduction of IVP (from 25.6 ± 2.4 to 17.9 ± 2.1 mm Hg, means ± SEM, -30%, P < .05), VPG (from 16.6 ± 2.4 to 10.8 ± 1.4 mm Hg, -35%, P < .05). TVP also reduced variceal size (from 9 ± 0.3 to 5.6 + 0.4 mm, -38%, P < .05) and WT (from 75.3 ± 11.6 to 30 ± 4.7 mm Hg. mm, -60%, P < .05). Intra-abdominal pressure decreased from 18 ± 2.2 to 4 ± 0.9 mm Hg (P < .05), and IVC decreased from 15.5 ± 2.4 to 5.7 ± 1.5 mm Hg (P < .05). No significant differences were observed in mean arterial pressure and heart rate. The mean ascitic fluid removed was 8 ± 0.71 L. No significant difference between measurements was observed in the control group. Our results show that TVP significantly decreases variceal pressure and tension. These results suggest that ascites removal can be useful in the treatment of variceal bleeding in cirrhotic patients.