In 83 patients with liver cirrhosis, an esophagogram after administration of barium sulfate, an endoscopic examination of the esophagus, and a portogram after percutaneous injection of an opaque material into the spleen were compared for diagnostic value in demonstrating esophageal varices. The diagnosis was established by esophagoscopy in 81, by splenoportography in 61, and by barium esophagogram in 55. Large varices were frequently missed by barium esophagograms as well as by splenoportograms. The mean splenic-pulp pressure was similar when patients with endoscopically demonstrated varices and normal portograms were compared with those whose portogram showed varices. Moreover, there was no apparent relation between portal pressure and variceal size. A time lapse between studies of as long as two months had no apparent influence on the incidence of positive diagnoses obtained.
Peternel WW, Dagradi AE, Rogers AI, Nadal HM, Perrin EB, Jackson FC. Clinical Investigation of the Portacaval ShuntIII. The Diagnosis of Esophageal Varices. JAMA. 1967;202(12):1081–1084. doi:10.1001/jama.1967.03130250063009