[Esophageal endoscopy for the assessment of risk of hemorrhage of esophageal hemorrhage].Z Gastroenterol. 1990 Aug; 28(8):405-7.ZG
Haemorrhage from oesophageal varices is still a life-threatening complication of portal hypertension. Parameters which are suitable to identify patients being at risk to bleed are urgently required to decide which patients should be candidates for prophylactic therapy. Recent studies showed that only 18% of bleeders present with small, however 49.9% with large varices. 80% had red color sign of the variceal wall and significantly higher intravariceal hydrostatic pressure (21.9 mmHg vs 14.7 mmHg, p less than 0.001) than patients without previous haemorrhage. Advanced liver disease (Child's C) is an additional risk factor. However, the clinical value of the endoscopic parameters is limited by a significant overlap of variceal size and pressure obtained in bleeders and non-bleeders. Thus, only patients with small varices, (Grade I), low variceal pressure (below 12 mmHg), and fair condition are unlikely to develop variceal bleeding. A significant additional clinical value of the parameters is provided by the fact that they allow accurate definition of patients with portal hypertension particularly for further clinical studies.