Background: Elevated variceal pressure leads to variceal bleeding. A simple device to noninvasively measure variceal pressure, and to determine the variables of variceal wall tension would allow the prediction of future variceal bleeding and the titration of medications to lower the intravariceal pressure. Purpose: To develop a noninvasive method which allows determination of intravariceal pressure. To develop a noninvasive method which will allow the determination of the variceal wall tension by measuring the variables of the Laplace equation, (transmural pressure, radius of the varix and wall thickness of the varix). To test this device in a model of esophageal varices. Methods: Two variceal pressure measurement devices were constructed. The first device consists of an Olympus UM-BS20-26R, 20 MHz ultrasound transducer placed next to a latex balloon catheter sheath with the balloon catheter attached to a pressure transducer. The second device was constructed by placing the same ultrasound transducer inside a latex contdom balloon attached to a pressure measuring device. These pressure measurement devices were tested in a blind fashion by inflating the balloon in order to compress and flatten each of four variceal models. Each variceal pressure was measured 10 times by two separate investigators blinded to the actual pressures within the model. The mean plus or minus the SD was calculated. The variceal models were made of a latex balloon filled with water. Each varix had the same diameter but a different intraluminal pressure. Results: The correlation coefficient between the actual and measured varix pressures for both devices ranged from .94 to .99. The percent error ranged from 0 to 10%. The correlation coefficient between the investigators making the blind measurements ranged from .97 to .99. Conclusion: Two variceal related pressure-measuring devices were developed, which are able to determine intravariceal pressure in a model varix system. These devices demonstrate a low percent error and a high correlation to the actual variceal pressures with low intra and interobserver variability. In addition to intravariceal pressure these devices have the potential to measure all to the variables of the Laplace eaquation for wall tension (transmural pressure, variceal radius and variceal wall thickness). We plan to test this device in human subjects.

compared to a historical control group who only received EVL to control the imtial variceal bleeding.Rebleeding rate were' calculated 6 months after eradication of the varices, or alter starting the medical treatment.Result: EVL efficiently controlled active vanceal bleeding in 95% of patients.Only 5 patients (5%) required a second endoscopic procedure within 48 hours to control the bleeding Rebleeding occurred in 12.5% in the Endoscopic intervention group alter repeated EVL, while in the SMT group rebleeding occuned in 8.5%, the difference was not statistically siguificant (p=0.5).However, the rebleeding rate was significantly" higher in the historical group, (26% versus 125% versus 8.5%) respectively (p=0.04).Conclusion: Medical therapy after initial control of variceal bleeding by band ligation is as effective as repeated band ligation in prevention of variceal rebleeding in ~histosomal/biCW co-mlected patients. GroupsControl (IEVL Once) Repeated EVL EVL followed by SliT % 26 12.5 8.5 p value 0.

compared to a historical control group who only received EVL to control the imtial variceal bleeding.Rebleeding rate were' calculated 6 months after eradication of the varices, or alter starting the medical treatment.Result: EVL efficiently controlled active vanceal bleeding in 95% of patients.Only 5 patients (5%) required a second endoscopic procedure within 48 hours to control the bleeding Rebleeding occurred in 12.5% in the Endoscopic intervention group alter repeated EVL, while in the SMT group rebleeding occuned in 8.5%, the difference was not statistically siguificant (p=0.5).However, the rebleeding rate was significantly" higher in the historical group, (26% versus 125% versus 8.5%) respectively (p=0.04).Conclusion: Medical therapy after initial control of variceal bleeding by band ligation is as effective as repeated band ligation in prevention of variceal rebleeding in ~histosomal/biCW co-mlected patients. GroupsControl (IEVL Once) Repeated EVL EVL followed by SliT % 26 12.5 8.5 p value 0.

BACKGROUND:Esophageal varices are a frequent source of bleeding in patients with cirrhosis. Elevated intravariceal pressure is associated with variceal bleeding. There is no simple, easy-to-use device for noninvasive measurement of intravariceal pressure. The purposes of this study were to develop a noninvasive method for measuring intravariceal pressure, and to develop a model of esophageal varices that can be used to test this pressure measurement device.METHODS:A variceal pressure measurement device was constructed by placing a 20 MHz US transducer in a latex balloon catheter sheath and attaching the catheter to a pressure transducer. The pressure measurement device was passed though the accessory channel of a large-channel endoscope and tested in blinded fashion by using tip deflection to compress each of 4 variceal models with the device. The pressure within each model was measured 10 times by 2 separate investigators blinded to the actual pressures. The mean (SD) pressure was calculated for each model. The variceal models were made of nitrocellulose dialysis tubing filled with water. Each "varix" had the same diameter but a different intraluminal pressure (5.5, 10, 15, 21.5 mm Hg).OBSERVATIONS:The correlation coefficient between the actual and measured "varix" pressures for the first investigator (L.S.M.) was r = 0.96: 99% CI [0.93, 0.98]. For the varix models with pressures of 21.5, 15, 10, and 5.5 the percent errors were, respectively, 9.5, 3.9, 5.1, and 0.7. The correlation coefficient between the actual and measured varix pressures for the second investigator (Q.D.) was r = 0.97: 99% CI [0.94, 0.98]. For the varix models with pressures of 21.5, 15, 10, and 5.5 the percent errors were, respectively, 10.3, 3.4, 9.8, and 1.1. The correlation coefficient between the 2 investigators (L.S.M., Q.D.) for the varix model pressures was r = 0.97: 99% CI [0.95, 0.99].CONCLUSION:The variceal pressure measuring device developed for this study measured intravariceal pressure in a model varix with a low percent error and high correlation to the actual pressures. Intraobserver and interobserver variability was low.