Les aspects endoscopiques de l'hypertension portale: Diagnostic et classification

During portal hypertension occurs the formation and/or opening of collateral circulations between the portal and caval systems. One of the most significant clinical consequences is the formation of endoluminal varices at the intestinal level. There is also congestion of the mucosa, termed portal congestive gastropathy or portal congestive colonopathy, depending on the area affected. Varices could be present in the entire gastro-intestinal tract (esophagus, stomach, duodenum, ileum, colon, rectum). However the most frequently observed are the esophageal varices and in case of rupture they cause severe haemorrhage. Bleeding from esophageal varices is one of the most important complications of liver cirrhosis and represents a critical moment for the endoscopist. Although the use of modern diagnostic and therapeutic technique, mortality during the first episode of bleeding still remains very high (30-40%). This is related not only to the entity of the haemorrhagic fact and the endoscopic ability to control it, but also to the degree of the liver disease, cardiopulmonary, kidney, infective and haemorrhagic complications. Endoscopic examination, if correctly performed, represents the best technique for the diagnosis, the classification and the therapeutic approach both in election and emergency.