Endoscopic retrograde cholangiopancreatography, but not esophagogastroduodenoscopy or colonoscopy, significantly increases portal venous pressure: Direct portal pressure measurements through endoscopic ultrasound-guided cannulation

J. M. Buscaglia, E. J. Shin, J. O. Clarke, S. A. Giday, C. W. Ko, P. J. Thuluvath, P. Magno, X. Dray, S. V. Kantsevoy

Research output: Contribution to journalArticle

Abstract

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±15.2mmHg vs. 13.4± 3.6mmHg at baseline, P = 0.006). Mean peak IVC pressure was also elevated during ERCP, but it did not reach statistical significance (24.0± 10.7mmHg vs. 12.6±4.1mmHg 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.

Original languageEnglish (US)
Pages (from-to)670-674
Number of pages5
JournalEndoscopy
Volume40
Issue number8
DOIs
StatePublished - Aug 1 2008

ASJC Scopus subject areas

  • Gastroenterology

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