Endoscopic markers of impending varceal hemorrhage: Correlation with the pressure in the varices

In 40 patients with cirrhosis and esophageal varices, transmural variceal pressure was assessed endoscopically by fine needle puncture and related to endoscopicsigns as well as to the severity of liver disease. Transmural pressure was significantly (p < 0.01) higher in the presence of a red color sign (26.7[7.8] cm H₂O) than in its absence (19.1 [6.6] cm H₂). Transmural pressure, however, was not significantly related to diameter or number of varices (diameter >5mm: 23.7 [8.4], diameter ≦ 5 mm: 22.2 [7.9] cm H₂0; number > 3: 23.2 [8.0], number ≦ 3: 22.2 [7.8] cm H₂O. The Child status (Child A: 23.9 [8.0], Child B/C: 21.3 [8.1] cm H₂O) and individual Child‐Pugh parameters including ascites (ascites present: 23.2 [8.3] cm H₂O, ascites absent: 22.8 [8.1] cm H₂O) were not significantly related to transmural variceal pressure. We conclude that the endoscopic visibility of a red color sign on the varices is associated with a high transmural esophageal variceal pressure. Our results favor the hypothesis that variceal pressure may be of major importance for the development of the red color sign.