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Échoendoscopie haute et hypertension portale au cours de la cirrhose

Upper endoscopic ultrasonography and portal hypertension in patients with cirrhosis

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Acta Endoscopica

Résumé

Durant cette dernière décennie, l’échoendoscopie haute a été appliquée par quelques équipes au diagnostic de l’hypertension portale chez le cirrhotique. Son rôle est limité dans la visualisation des varices œsophagiennes, l’endoscopie lui étant supérieure. Son apport réside dans la meilleure détection des varices gastriques et la mise en évidence des sytèmes veineux péri-oesophagien et péri-gastrique. Elle peut contribuer au diagnostic de la gastropathie congestive. La correspondance avec les aspects endoscopiques n’est toutefois pas clairement établie. Elle pourrait jouer un rôle dans le diagnostic plus précoce de l’hypertension portale. Elle n’a cependant pas fait l’objet d’études comparatives dans cette situation avec l’échographie doppler couleur transcutanée. Elle devrait permettre de définir de nouveaux facteurs prédictifs du risque d’hémorragie digestive, peut-être contribuer au choix du traitement, aux contrôles immédiat et à distance de la sclérothérapie. L’intérêt d’une classification des anomalies œsogastriques observées au cours de l’hypertension portale du cirrhotique parait important si l’on veut continuer l’évaluation de cette technique dans cette indication.

Summary

In the past decade, upper endoscopic ultrasonography has been applied by several teams to the diagnosis of portal hypertension in cirrhotic patients. The technique is limited with regard to the visualization of esophageal varices, endoscopy being far superior. Its advantage lies in a better detection of gastric varices and revealing the periesophageal and perigastric venous systems. It could contribute to the diagnosis of congestive gastropathy. The relationship with endoscopic findings, however, has not been clearly established. It could play a part in the earlier diagnosis of portal hypertension. In this case, there are, however, no comparative studies with transcutaneous colour Doppler ultrasonography. It should allow to define new predictive risk factors of digestive hemorrhage, maybe help in the choice of treatment and monitor sclerotherapy, both immediately and in the long term. The relevance of a classification of esogastric anomalies observed in portal hypertension of cirrhotic patients seems to be important if the evaluation of this technique in this indication is to be continued.

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  1. J. -Ch. Audigier

    Present address: Service de Gastroentérologie et d’Hépatologie, Hôpital Nord, CHU de Saint-Etienne, F-42055, Saint-Etienne Cedex 2

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  1. Service de Gastroentérologie et d’Hépatologie, Hôpital Nord, CHU de Saint-Etienne, F-42055, Saint-Etienne Cedex 2

    O. Dumas, J. -Ch. Letard, P. Richard & C. Barthélémy

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Dumas, O., Letard, J.C., Richard, P. et al. Échoendoscopie haute et hypertension portale au cours de la cirrhose. Acta Endosc 25, 337–346 (1995). https://doi.org/10.1007/BF02963252

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