Endoscopic manometry of esophageal varices: evaluation of a balloon technique compared with direct portal pressure measurement

Background/Aims: Recently, a non-invasive endoscopic balloon technique for esophageal manometry was published. In the present study, we assess its methodological aspects together with the relationship to portal pressure. Methods: In 20 patients with liver cirrhosis who had received an intrahepatic portosystemic stent-shunt (TIPS), we evaluated portal and variceal pressure before and after balloon occlusion of TIPS (random order). Portal pressure was measured continuously via a portal venous catheter, and variceal pressure was determined at the same time independently by two endoscopists using two balloon techniques (inflation until varix colapses; deflation until varix reappears). Results: Overall, mean (±SD) portal pressure (28.5±7 mmHg) was significantly higher (p<0.001) than mean variceal pressure (24.4±6 mmHg). Balloon manometry-determined variceal pressure values were 10–15% higher with the inflation technique (26.2±7 mmHg) than with the balloon deflation technique (22.6±6 mmHg, p<0.001). Portal pressure and variceal pressure correlated significantly (p<0.001; balloon inflation: r=0.61, balloon deflation: r=0.66, mean values of inflation and deflation: r=0.68). Short-term TIPS occlusion led to mean increases of 52% and 35% in portal pressure and variceal pressure, respectively. The manometry results of both endoscopists correlated well with either balloon technique (r≥0.93; p<0.001) and we saw no adverse effects. Conclusions: Variceal balloon manometry provides non-invasive variceal pressure data which correlate to portal pressure assessed prior to and after short-term TIPS occlusion. However, probably due to variance in collateral anatomy, variceal pressure does not exactly predict portal pressure and its acute changes in the individual patient. The averaged variceal pressure of the inflation and deflation balloon technique provides the best relation to portal pressure combined with a good interobserver reliability and warrants further clinical evaluation.