4586 Duplex doppler endosonography: a new gold standard for the diagnosis of portal vein thrombosis.

Objective: to determine the feasibility, the diagnostic value and the therapeutic impact of EUS in the diagnosis of portal vein thrombosis. Subjects and methods : 71 patients , mean age 52 years (24-84 years) with portal hypertension were studied retrospectively with EUS for suspicion of portal vein thrombosis (Duplex sonography or CT). EUS was compared to the sonography (US) results, then to angiography (ACM) and to surgery (considered as gold standards). Results : In 59 US, a diagnosis was made in 55,9% of cases. In 44,1%, the diagnostic was uncertain, particularly on spleno-mesenteric confluence. In 71 EUS, achieved without mortality nor morbidity, a diagnosis was made in 97,2% with diagnostic doubt in 2,8% of cases. 49 portal thrombosis were diagnosed by EUS ( 19/49 were partial thrombosis, never specified by the ACM). In 26 cases on 49, agreement between EUS and ACM was found. In 6 cases on 49, EUS corrected the diagnosis of ACM. 17 cases on 49 had no ACM, but a surgery (liver transplantation or derivation) was only decided on EUS. It existed 2 false positive diagnosis in EUS, these two patients have been transplanted. The diagnostic value of EUS is excellent (Fisher s exact test : p