Evaluation of portacaval shunt patency with the differential glucose tolerance test

Abstract

A method has been described for establishing shunt patency by determining the difference in postprandial plasma glucose levels between a peripheral vein and the inferior vena cava at or near the site of the portal-systemic anastomosis. This tet was evaluated both in the laboratory with normal dogs before and after Eck fistula formation as well as cirrhotic patients with and without shunts. The results indicate that this test is reliable and has the advantages of safety, specificity, and ease of performance.

FIG. 1

Technique of sampling for differential glucose tolerance test in human beings. The inferior vena caval catheter is inserted percutaneously to, or just above, the anastomotic site. Peripheral venous samples are obtained from a vein of the arm. Samples from the 2 sites are drawn simultaneously, before and after a glucose meal.

FIG. 2

Concentration differences of plasma glucose between the suprarenal inferior vena cava and the jugular vein in dogs before and after a glucose meal. The line graphs represent mean values, and the vertical cross bars are the standard errors. The lower curve represents normal dogs and the upper curve the same group of dogs after performance of Eck fistulas. “I” refers to inferior vena cava samples and “P” to the peripheral, jugular, sample.

FIG. 3

Concentration differences of plasma glucose between the suprarenal inferior vena cava (I) and the arm veins (P) of cirrhotic patients before and after ingestion of 100 grams of glucose orally. Points are mean values and the vertical cross bars standard errors. The lower curve represents cirrhotic patients who were not operated upon. The upper curve represents cirrhotic patients in whom a portacaval or splenorenal shunt had been established.