THE ERECTION AND DETUMESCENCE OF ESOPHAGEAL VARICES

¹ From the Department of Radiology, University of California School of Medicine, and the Veterans Administration Hospital, San Francisco, California
² From the Department of Medicine, University of California School of Medicine, and the Veterans Administration Hospital, San Francisco, California

In some cirrhotics dextran infusion has enhanced visualization of esophageal varices. The explanation may be either a nonspecific increase in the blood volume, or an increased flow through the collateral circulation. The increase may be secondary to a greater rise in portal vein pressure than in central venous pressure.

Indirect estimation of the portal vein pressure after dextran infusion showed a greater rise than that of the central venous pressure in 4 patients. In only 1 of these did varices become apparent for the first time, which was confirmed by endoscopy.

Pitressin caused the disappearance of varices with a fall in portal pressure in an additional patient.

Infusion of dextran may be helpful in those patients in whom endoscopy is contraindicated: e.g., cardiac arrhythmias or severe cervical osteoarthritis. It should not be used in ascitic patients,⁶ since the reduced distensibility of the splanchnic bed¹ in these patients might provoke rupture of the varix.

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