Background and study aims: Changes in portal pressure during endoscopy have not been previously evaluated. The
aims of this study were to assess the effect of esophagogastroduodenoscopy (EGD),
colonoscopy, and endoscopic retrograde cholangiopancreatography (ERCP) on portal vein,
inferior vena cava (IVC), and systemic pressures.
Patients and methods: Five acute experiments were performed on 50-kg pigs utilizing endoscopic ultrasound
(EUS)-guided catheterization of the portal vein and IVC. Systemic, intra-abdominal,
IVC, and portal vein pressures were monitored during colonoscopy, EGD, and ERCP with
endoscopic sphincterotomy. After endoscopy the animals were sacrificed for necropsy.
The main outcome measure was pressure change during each type of endoscopic procedure.
Results: There were no significant changes in heart rate or systemic pressure during all endoscopic
procedures. Intra-abdominal pressure increased during colonoscopy (P = 0.02) and ERCP (P = 0.007). However, mean portal venous pressure was significantly elevated only after
the injection of contrast into the common bile duct, reaching its peak value at the
time of biliary sphincterotomy (39.0 ± 15.2 mm Hg vs. 13.4 ± 3.6 mm Hg at baseline,
P = 0.006). Mean peak IVC pressure was also elevated during ERCP, but it did not reach
statistical significance (24.0 ± 10.7 mm Hg vs. 12.6 ± 4.1 mm Hg at baseline, P = 0.06).
Conclusion: EGD and colonoscopy did not cause significant changes in portal vein, IVC, or systemic
pressures. ERCP with biliary sphincterotomy increased portal pressure with only limited
effect on IVC and systemic pressures. These new data indicate a possible connection
between ERCP with sphincterotomy and portal pressure, and may be clinically important
for patients with liver disease and other causes of portal hypertension who undergo
this procedure.
References
svkan@jhmi.edu
