Application of detachable string-magnetically controlled capsule endoscopy in the evaluation of post-endoscopic treatment of 50 liver cirrhosis patients with esophagogastric varices during follow-up / 中华消化杂志

Objective:To explore the value of detachable string-magnetically controlled capsule endoscopy (DS-MCE) in the evaluation of post-endoscopic treatment of liver cirrhosis patients with gastroesophageal varices during follow-up, and conventional electronic esophagogastroduodenoscopy (EGD) was used as the gold standard.Methods:From July 1, 2019 to December 31, 2021, 50 follow-up patients with gastroesophageal varices due to liver cirrhosis and had a past medical history of endoscopic treatment in Ruijin Hospital, Shanghai Jiaotong University School of Medicine were selected. DS-MCE and EGD were performed in turn. The 2 endoscopic examination methods were compared and analyzed in the assessment of detecting gastroesophageal varices, grading of diameter of esophageal varices and classification of bleeding risk factors (including sensitivity, specificity, positive predictive value and negative predictive value), diagnosis of portal hypertensive gastropathy and its severity, and the patients′ satisfaction (pre-procedural perceptual and post-procedural satisfaction). Kruskal-Wallis test and Kappa test were used for statistical analysis.Results:The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of esophageal varices were 100.0% (43/43), 85.7%(6/7), 97.7% (43/44) and 100.0%(6/6), respectively.The accuracy of DS-MCE in evaluating the grading of esophageal varices was 86.0% (43/50), with good consistency of EGD, and the Kappa value was 0.797 ( P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of esophageal varices with bleeding risk factors were 94.4% (34/36), 100.0%(14/14), 100.0% (34/34) and 87.5%(14/16), respectively. The accuracy of DS-MCE in evaluating esophageal varices with bleeding risk factors was 94.0% (47/50), with good consistency of EGD, and the Kappa value was 0.862 ( P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of gastric varices were 85.7% (18/21), 93.1% (27/29), 90.0% (18/20) and 90.0% (27/30), respectively. The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of portal hypertensive gastropathy were all 100.0% (50/50). The consistency of DS-MCE and EGD in the severity grading of portal hypertensive gastropathy was good, the Kappa value was 0.962 ( P<0.001). The results of pre-procedural perceptual analysis showed that patients′ psychological tension before examination and expected pain before examination of DS-MCE were better than those of EGD ( H=16.04 and 23.74, both P<0.001). The results of satisfactory analysis after examination indicated that DS-MCE was better than EGD in the degree of difficulty in swallowing, pain and discomfort during examination, pain and discomfort after examination, comfort degree during examination, convenience of the procedure and willingness of receiving such examination again as gastric examination method ( H=17.28, 30.88, 44.68, 34.66, 48.05, 22.74, 13.03 and 17.19, all P<0.001). Conclusions:With EGD as the gold standard, DS-MCE can accurately evaluate gastroesophageal varices and portal hypertensive gastroenteropathy after endoscopic treatment in patients with liver cirrhosis and gastroesophageal varices, and it is a safe and comfortable method. DS-MCE can be an efficient alternative method in endoscopic follow-up of such patients.

Transformación cavernomatosa de vena porta asociada a trombocitemia esencial oculta

RESUMEN La transformación cavernomatosa de vena porta es una condición caracterizada por la formación de una red de venas colaterales dilatadas a lo largo de una vena porta previamente trombosada. Es considerada una entidad de baja frecuencia y se presenta más comúnmente en población pediátrica. Presentamos el caso de una mujer adulta con diagnóstico de transformación cavernomatosa de vena porta, originado como consecuencia de una trombocitemia esencial oculta. Como medida terapéutica a la hipertensión portal se realizó una ligadura endoscópica de várices gastroesofágicas en múltiples oportunidades sin resultados positivos. No se practicó derivación portosistémica por la presencia de abundantes colaterales. Finalmente, se realizó una esplenectomía, posterior a lo cual se logró evidenciar una trombocitemia esencial. La paciente evolucionó con múltiples complicaciones médico-quirúrgicas, que la llevaron a una falla multisistémica y posterior fallecimiento. No existen datos de prevalencia regional ni se han reportado casos de transformación cavernomatosa de vena porta asociado a trombocitemia esencial por lo que consideramos de gran importancia dar a conocer este caso, de modo a poder ayudar a establecer con mayor precisión y rapidez el diagnóstico y tratamiento de esta rara entidad.

ABSTRACT Cavernous transformation of the portal vein is a condition characterized by the formation of a network of dilated collateral veins along a previously thrombosed portal vein. It is considered a low-frequency entity and occurs more commonly in the pediatric population. We present the case of an adult woman with a diagnosis of cavernous transformation of the portal vein, originated as a consequence of occult essential thrombocythemia. As a therapeutic measure for portal hypertension, endoscopic ligation of gastroesophageal varices was performed on multiple occasions without positive results. Portosystemic bypass was not performed due to the presence of abundant collaterals. Finally, a splenectomy was performed, after which essential thrombocythemia was evidenced. The patient evolved with multiple medical-surgical complications, which led to multisystem failure and subsequent death. There are no regional prevalence data, nor have there been reports of cavernous transformation of the portal vein associated with essential thrombocythemia, for which reason we consider of great importance to make this case known, in order to help establish the diagnosis and treatment of this rare entity with greater precision and speed.

Safety and efficacy of a novel shunt surgery combined with foam sclerotherapy of varices for prehepatic portal hypertension: a pilot study

OBJECTIVES: This pilot study investigated the safety and efficacy of a novel shunt surgery combined with foam sclerotherapy of varices in patients with prehepatic portal hypertension. METHODS: Twenty-seven patients who were diagnosed with prehepatic portal hypertension and underwent shunt surgeries were divided into three groups by surgery type: shunt surgery alone (Group A), shunt surgery and devascularization (Group B), and shunt surgery combined with foam sclerotherapy (Group C). Between-group differences in operation time, intraoperative blood loss, portal pressure decrease, postoperative complications, rebleeding rates, encephalopathy, mortality rates and remission of gastroesophageal varices were compared. RESULTS: Groups A, B and C had similar operation times, intraoperative bleeding, and portal pressure decrease. The remission rates of varices differed significantly (p<0.001): one patient in Group A and 6 patients in Group B had partial response, and all 9 patients in Group C had remission (2 complete, 7 partial). Two Group A patients and one Group B patient developed recurrent gastrointestinal bleeding postoperatively within 12 months. No postoperative recurrence or bleeding was observed in Group C, and no sclerotherapy-related complications were observed. CONCLUSIONS: Shunt surgery combined with foam sclerotherapy obliterates varices more effectively than shunt surgery alone does, decreasing the risk of postoperative rebleeding from residual gastroesophageal varices. This novel surgery is safe and effective with good short-term outcomes.

Prospective study on endoscopic selective varices devascularization and traditional tissue glue injection / 中华消化杂志

Objective To evaluate the clinical efficacy and safety of endoscopic selective varices devascularization.Methods From November 2015 to July 2017,at the First Affiliated Hospital of Anhui Medical University,282 patients with liver cirrhosis complicated with gastroesophageal varices who underwent endoscopic treatment were selected and divided into traditional treatment group (n=102) and selective treatment group (n=180).The patients of traditional treatment group were treated with tissue glue "sandwich method" (lipiodol-tissue glue-lipiodol),and the patients of selective treatment group were treated with modified " sandwich method" (lauromacrogol-tissue glue-0.9％ sodium chloride solution).After operation,all the patients were followed up for three months.The rates of remarkable efficacy,efficacy,improvement,rebleeding and complications were compared between the two groups respectively.T test,chi-square test and rank sum test were performed for groups comparison.Results One month after operation,the rates of remarkable efficacy and efficacy of the traditional treatment group and the selective treatment group were 46.1％ (47/102) and 20.6％ (21/102),and 67.8％ (122/180) and 30.0％ (54/180),respectively.The results of rank sum test indicated that the differences in rates of remarkable efficacy and efficacy between two groups were statistically significant (Z=-5.428,bilateral P＜0.05).The improvement rate of the selective treatment group was higher than that of the traditional treatment group (97.8％,176/180 vs.66.7％,68/102),and the difference was statistically significant (x2-54.048,P＜ 0.05).At two weeks and three months after operation,the rebleeding rate of traditional treatment group was higher than that of selective treatment group (10.8 ％,11/102 vs.3.3 ％,6/180;21.6％,22/102 vs.7.2％,13/180),and the difference was statistically significant (x2 =6.380 and 12.327,both P＜0.05).No serious complications occurred in both groups.There was no statistically significant difference in overall complication rate between selective treatment group and traditional treatment group (37.8％,68/180 vs.30.4％,31/102;x2 =1.559,P-0.212).Conclusion The treatment with endoscopic selective varices devascularization shows good efficacy and safety,and is worth further study.

Feasibility of splenectomy and pericardial devascularization in patients with Child-Pugh grade C cirrhosis and portal hypertension / 中华肝胆外科杂志

Objective To evaluate the feasibility of splenectomy and pericardial devascularization in patients with Child-Pugh grade C cirrhosis,portal hypertension,and severe hypersplenism or after the first gastroesophageal variceal hemorrhage (GEV bleeding).Methods From January 2010 to January 2017,the clinical data from patients with Child-Pugh grade C cirrhosis,portal hypertension with a high risk of GEV bleeding were retrospectively analyzed.These patients underwent splenectomy and pericardial devascularization at the Huashan Hospital Affiliated to the Fudan University.The safety and effectiveness of surgery,postoperative complications and mortality were further explored.Results Liver protection treatment was given before surgery to improve the liver function.Of the 32 patients who underwent splenectomy and pericardial devascularization,the operation time was (2.2±0.3) hours.The blood loss was (208.0± 102.0) ml and the hospital stay after surgery was (11.8±2.8) d.Postoperative complications included fever,wound infection and ascites.One patient died of hypovolemic shock and acute renal failure.The incidence of postoperative PVT was 12.5％ (4/32).The rates of GEV rebleeding at 1 year,3 years,and 5 years after surgery were 6.3％ (2/32),6.3％ (2/32),and 9.4％ (3/32).The 5-year overall mortality rate was 12.5％ (4/32).Conclusions In the absence of obvious surgical contraindications and with a lack of donor livers for liver transplantation,aggressive perioperative management,splenectomy and pericardial devascularization are a feasible option for patients with Child-Pugh grade C cirrhosis,portal hypertension with a high risk of GEV bleeding.

Endoscopic clipping with histoacryl in management of type 2 gastroesophageal varices (30 cases) / 中国内镜杂志

Objective To summarize clinical experience and explore application value of endoscopic clipping with histoacryl using in management of type 2 gastroesophageal varices. Methods Clinical data of 30 patients with type 2 gastroesophageal varices patients (including acute hemorrhage and primary prevention) from May 2015 to December 2016 were collected. Then evaluate therapeutic effect and safety of endoscopic clipping adjuvant therapy. Results Average glue dosage was (1.46 ± 0.70) ml, average using of clips were (5 ~ 6), and intraoperative needle pulling hemorrhage occurred in 2 cases. 14 patients (46.7%) underwent endoscopic re-examination, 3 patients (10.0%) achieved varicose vein elimination, 11 cases (36.7%) remained residual. Rebleeding occurred in 4 cases (13.3%), and 2 cases died (6.7%), one because of postoperative hematemesis and hemorrhagic shock, the other one died of spontaneous peritonitis and septic shock. For general curative effect, 2 cases (6.7%) were healed, 22 cases (73.3%) were improved, and 6 cases were unhealed (20.0%, 4 cases occurred rebleeding, 2 cases died); 17 cases underwent CT portal venograpy, abnormal embolization was not found in any patients, glue extrusion bleeding occurred in 1 case (3.3%), no patients had severe postoperative complications. Conclusion Endoscopic clipping with histoacryl can be used in the prevention and treatment of type 2 gastroesophageal varices to improve the treatment effect and reduce postoperative bleeding risk, may have good clinical practice value.

Risk factor analysis for portal vein thrombosis in 591 patients with liver cirrhosis / 复旦学报（医学版）

Objective To observe the risk factors for portal vein thrombosis (PVT) in cirrhotic patients prior to receiving endoscopic treatment to prevent gastroesophageal varices rebleeding.Methods A retrospective analysis was conducted on cirrhotic patients admitted to Zhongshan Hospital,Fudan University from 2008 to 2013 for secondary prevention of gastroesophageal varices bleeding via endoscopic treatment.Relevant information and data were collected,followed by an univariate analysis and multiple Logistic regression analysis in attempt to identify potential factors affecting the formation of PVT.Results Totally 591 patients were enrolled in the present study and were classified as present-PVT group (n =122,20.64 ％) and absent-PVT group (n =469,79.36 ％).Univariate analysis showed that MELD score,hemoglobin,platelet count,total bilirubin,alanine aminotransferase,blood urea nitrogen,splenectomy ratio all achieved statistical significance between the two groups (P＜0.05).The multiple Logistic regression showed that MELD score,lowered blood urea nitrogen,elevated D-dimer and history of splenectomy were independent factors associated with the formation of PVT (P values were separately 0.016,0.026,0.014 and ＜0.001).Conclusions Cirrhotic patients should receive regular surveillance for MELD score,liver function,D-dimer and portal vein ultrasonography,especially in patients received with a previous history of splenectomy.

Actualización en el manejo de la hemorragia digestiva alta variceal / Update on the management of variceal upper gastrointestinal bleeding

Variceal bleeding is a severe complication of portal hypertension, associated to hepatic cirrhosis. It is more frequent in esophageal varices than in gastric varices. The first-line treatment is resuscitation, careful intravenous saline fluids infusions, prophylactic antibiotics and early combined use of vasoactive drugs and endoscopic therapy. Despite these measures, haemostasis failure is of 20 percent after 6 weeks. In these patients, the second-line treatment is transjugular intrahepatic portosystemic shunt (TIPS), procedure that requires an interventional radiologist. Therapeutic options are evaluated for bleeding esophageal varices, such as TIPS with covered stent as first-line treatment, portosystemic shunt surgery in Child-Pugh A patients as alternative to TIPS, the use of recombinant FVII in massive bleeding established by endoscopy and selfexpandable metallic stent in Child-Pugh B-C patients, instead of balloon. For gastric varices the use of balloon retrograde transvenous occlusion (BRTO) is described.

El sangrado variceal es una complicación grave de la hipertensión portal asociada a cirrosis hepática. Es más frecuente en várices esofágicas que gástricas. Como primera línea de tratamiento está la resucitación, volemización cuidadosa, profilaxis antibiótica y el uso combinado precoz de drogas vasoactivas junto a terapia endoscópica. A pesar de estas medidas, la hemostasia fracasa hasta en 20 por ciento a 6 semanas. En estos pacientes, la segunda línea de tratamiento es el Cortocircuito intrahepático portosistémico transyugular (Transjugular Intrahepatic Portosystemic Shunt- TIPS), procedimiento que requiere la participación de un radiólogo intervencionista. Se evalúan opciones terapéuticas para várices esofágicas sangrantes como el TIPS con stent recubierto usado de primera línea, la cirugía de shunt portosistémico en pacientes Child A como alternativa al TIPS, el uso de FVII recombinante en sangrado variceal masivo detectado mediante endoscopia, y el stent metálico autoexpandible en Child B-C en vez de balón. Para várices gástricas se describe el uso del balón oclusivo retrógrado transvenoso (B-RTO).

A randomized trial of endoscopic variceal ligation versus cyanoacrylate injection for treatment of bleeding junctional varices.

Background : There is scarcity of data concerning the management of bleeding junctional gastroesophageal varices. Aim: Our aim was to compare the efficacy and safety of endoscopic variceal ligation (EVL) with cyanoacrylate injection for the treatment of bleeding junctional varices. Methods: One hundred fifty patients with bleeding junctional varices were included in the study. Patients were subjected after randomization to either EVL of junctional varices (group l: 75 patients) or cyanoacrylate injection (group ll: 75 patients). Endoscopic sessions were continued till obliteration of the varices. Clinical as well as biochemical parameters and severity of liver disease were assessed in all patients. Results: Control of active variceal bleeding was achieved in 61 patients (81%) in group I and in 68 patients (91%) in group II with no significant difference (p =0.07). Re-bleeding was seen in 12 patients (16%) in group I and 5 patients in group II (6%). Junctional varix obliteration was achieved after one session in 33% of patients in group I and 52% of patients in group II, however after 2 sessions it was achieved in 67% in group I and 93 % in group II. After 3 sessions variceal obliteration was achieved in 99% in group l. Fever, chest pain and dysphagia were observed more frequently in group II than in group I. Long term complications including spontaneous bacterial peritonitis, hepatic encephalopathy and hepatorenal syndrome were also observed more frequently group II than in group I. Conclusion: EVL may be a good alternative to cyanoacrylate injection in treatment of bleeding junctional varices.

Manejo de várices gastroesofágicas: revisión de la evidencia y consenso: metodología y organización de las guías / Management of gastroesophageal varices: evidence-based review and consensus: methodology and organization of the guidelines

Introduction: There is plenty of scientific evidence regarding the management of esophageal varices, but sometimes it is contradictory. International consensuses carried out in America and Europe are evidence based, however these do not include a comprehensive analysis on the quality of the studies. The purpose of this review is to establish a national consensus, by means of relevant questions regarding the management of gastroesophageal varices, to provide detailed information on related evidence, thus, establishing reasonable behaviors based on the national scenario. Methodology: The guidelines are organized following 15 clinically relevant questions on the management of gastroesophageal varices, including primary prophylaxis, interventional pharmacological, endoscopical and radiological treatment of variceal hemorrhage until secondary prophylaxis. Quality assessment of the evidence supporting each asseveration will be descriptive and will be based mainly in the design of the studies, adapted from the recommendations of the U.S. Preventive Services Task Force. Then, the group of experts will make a recommendation for each intervention in response to each question. The consensus will be achieved by a Delphi approach of 2 rounds, and the third round will be achieved in the national consensus to be carried out in June 2010 during the Course on Advances in Gastroenterology, with the participation of the audience, using an electronic board where the questions will be answered in actual time. Preliminary results: The survey includes 15 open questions which were distributed among the 12 experts who will provide responses according to levels/degrees of evidence and recommendations. Conclusions: Definitive results of the national consensus will be presented during the Course on Advances in Gastroenterology 2010 and will be published in the Gastroenterología Latinoamericana journal. This methodology can be replicated in the future in other areas ...

Introducción: La evidencia científica en relación al manejo de las várices gastroesofágicas es abundante y muchas veces contradictoria. Los consensos internacionales realizados en América y Europa son basados en la evidencia, sin embargo, no incluyen un análisis detallado de la calidad de los estudios incluidos. El objetivo de la presente revisión es establecer un consenso a nivel nacional, a través de preguntas relevantes en el manejo de las varices gastroesofágicas, detallar la evidencia relacionada y establecer así conductas racionales, considerando la realidad nacional. Metodología: Las guías están organizadas en relación a 15 preguntas clínicas relevantes en el manejo de las várices gastroesofágicas que incluyen la profilaxis primaria, tratamiento farmacológico, endoscópico y radiológico intervencional de la hemorragia variceal hasta la profilaxis secundaria. La evaluación de la calidad de la evidencia que sustenta cada afirmación se realizará en forma descriptiva, fundamentándose primordialmente en el diseño de los estudios, adaptado de las recomendaciones realizadas por la U.S. Preventive Services Task Force. Luego el panel de expertos realizará una recomendación para cada intervención en respuesta a cada pregunta clínica. El consenso se realizará mediante una técnica Delfi de 2 rondas y la tercera ronda se realizará durante el consenso nacional a realizarse en el curso de avances en gastroenterología en junio de 2010 con participación de la audiencia mediante teclera electrónica con respuestas en tiempo real. Resultados preliminares: La encuesta incluye 15 preguntas abiertas distribuidas entre el panel de 12 expertos nacionales que deberán responder de acuerdo a la pauta de niveles de evidencia y grados de recomendación. Conclusión: Los resultados definitivos del consenso nacional serán expuestos durante el curso de avances en gastroenterología 2010 y publicados en la Revista Gastroenterología Latinoamericana. Esta metodología puede ser...

Prevention and Management of Gastroesophageal Variceal Hemorrhage / 대한소화기내시경학회지

Gastroesophageal variceal hemorrhage involving increased portal pressure is the most common fatal complication of liver cirrhosis. Gastroesophageal varices are present in approximately 50% of patients with liver cirrhosis. Although acute variceal hemorrhage-related mortality has decreased significantly over the last decade, it still is at least 20% at 6 weeks after variceal bleeding even with optimal management. In patients with medium and large varices that have not bled but have a high risk of hemorrhage, nonselective beta-blockers or endoscopic variceal ligation may be recommended for the prevention of first variceal hemorrhage. Acute variceal hemorrhage requires intravascular volume support and blood transfusions with vasoconstrictive agents and prophylactic antibiotics. Endoscopic variceal ligation and nonselective beta-blockers are standard secondary prophylaxis therapies for variceal bleeding. Patients whose hepatic venous pressure gradient decreases to <12 mmHg or at least 20% from baseline levels after treatment with nonselective beta-blockers can reduce the probability of recurrent variceal hemorrhage. In gastric fundal varices, endoscopic variceal obturation using cyanoacrylate is preferred. For failures of medical therapy, a transjugular intrahepatic portosystemic shunt or surgically created shunts are salvage procedures.

Prevention and management of gastroesophageal varices / 대한내과학회지

Gastroesophageal varices are the most common lethal complication of cirrhosis that result most directly from portal hypertension. Patients with cirrhosis and gastroesophageal varices have an hepatic venous pressure gradient (HVPG) of at least 10~12 mmHg. An increased portal pressure gradient results from both an increase in resistance to portal flow and an increase in portal blood inflow. Patients whose HVPG decreased to < 12 mmHg or at least 20% from baseline levels have a lower probability of developing recurrent variceal hemorrhage. Therefore, a reduction in HVPG is most important. Nonselective beta-blockers are the gold standard in the prevention of first variceal hemorrhage in pateints with medium/large varices. Endoscopic variceal ligation (EVL) has been established as an alternative to nonselective beta-blockers for the prevention of initial variceal hemorrhage. The combination of vasoconstrictive pharmacological therapy and variceal ligation is the preferred approach to the management of acute variceal hemorrhage. Prophylactic antibiotic therapy is considered standard of care as adjunctive treatment of the acute bleeding episode. Both combination pharmacological therapy and EVL have been proven effective for the prevention of recurrent variceal hemorrhage. For failures of medical therapy, TIPS or surgically created shunts are excellent salvage procedures.

Comparison between PTVE of TH glue embolization through gastroesophageal and percutanenous and treatment of esophageal varices by variceal ligation / 中国医师进修杂志

Objective To study the possibility and effects of fixed TH glue embolization through gastroesophageal and percutanenous. Methods Forty-six patients of bleeding esophageal varices were divided randomly into two groups: in treatment group:twenty-five patients treated with TH glue (?-cyanoacrylate) embolization PTVE+PSE. Absolute alcohol-cilia steel ring-TH glue ,but in control group, 21 patients of esophageal varices by variceal ligation. Analysis the percentage of rebleeding, death rate and improvement rate of liver functions. Results In the treatment group,the rebleeding of gastroesophageal varices was 8.7%, the percentage of death was 4.3%, the function of liver improved by 87.0% . In the control group, the percentage of rebleeding was 28.6%, death rate was in 19.1% and liver function improved by 48.0%. Conclusion PTVE+PSE fixed TH glue embolization is safe, less destroyed. Compared with dense edoscopic ligation, DEVL, the advantage is lessre bleeding, less death rate and higher liver function improvement rate. It is an effective method for gastroesophageal varices.

Analysis of the Factors of Esophageal-Gastric Varices in Portal Hypertension / 实用放射学杂志

Objective To evaluate the correlation of the CT features of the collateral circulation and the degree of esophageal-gastric varices in patients with portal hypertension caused by hepatic cirrhosis.Methods 30 cases with portal hypertension were in group A and 30 healthy people were in group B.The diameter of portal vein(PV),gastriccoronary vein(GCV),the total cross-sectional surface area(CSA) of varices in gastro-splenic region were measured in both group A and B,the results and endoscopic signs were analysed with multiple linear regression.Results The diameters of PV were(16.17?2.44) mm in group A and(12.42?1.53) mm in group B,Beta =0.39. The diameters of GCV were(6.22?2.41)mm in group A and (3.39?1.03) mm in group B,Beta =0.85. The total CSA of varicosis in gastro-splenic region were(5.14?5.96) cm2 in group A and (1.32?0.98) cm2 in group B, Beta =1.90. Multiple linear regression equation : y=0.39X1+0.85X2+1.90X3 Conclusion The total CSA of varicosis in gastro-splenic region is a useful CT feature in evaluating portal hypertension.