Endoscopy 2001; 33(10): 869-872
DOI: 10.1055/s-2001-17339
Short Communication

© Georg Thieme Verlag Stuttgart · New York

Hemodynamic Analysis of Esophageal Varices Using Color Doppler Endoscopic Ultrasonography to Predict Recurrence After Endoscopic Treatment

S. Hino, H. Kakutani, K. Ikeda, H. Yasue, Y. Kitamura, K. Sumiyama, Y. Uchiyama, A. Kuramochi, K. Matsuda, H. Arakawa, K. Hachiya, M. Kawamura, K. Masuda, H. Suzuki
  • Department of Endoscopy, Jikei University School of Medicine, Tokyo, Japan
Further Information

Publication History

Publication Date:
20 September 2001 (online)

Background and Study Aims: The time to recurrence of esophageal varices may vary greatly between patients even after the same endoscopic therapy. To clarify the factors which contribute to recurrence after endoscopic treatment, the hemodynamics and morphology of the left gastric vein (LGV) were investigated using color Doppler endoscopic ultrasonography (EUS).

Patients and Methods: A total of 31 patients with high-risk esophageal varices underwent color Doppler-EUS before receiving endoscopic variceal ligation and endoscopic injection sclerotherapy combined therapy. Endoscopic examination was performed every 3 months after the treatment to evaluate recurrence of varices.

Results: A total of 18 patients responded to the therapy, while 13 patients did not respond, and had recurrence within 12 months. The hepatofugal flow velocity in the LGV trunk was significantly lower in the responders (9.9 vs. 13.9 cm/sec; P = 0.02). The branch pattern of the LGV was categorized into three groups: anterior branch dominant, posterior branch dominant, and no-dominant type. The incidence of the anterior branch dominant type was significantly less in responders (17 vs. 70 %; P = 0.01). There was no significant difference in the LGV trunk diameter and the size of the paraesophageal vein between the two groups.

Conclusion: Risk factors for recurrence can be analyzed in detail using color Doppler-EUS. Further investigation using color Doppler-EUS may enable us to select the optimal way to treat esophageal varices to prevent recurrence.

Reference

  • 1 Takase Y, Shibuya S, Chikamori F, et al. Recurrence factors studied by percutaneous transhepatic portography before and after endoscopic sclerotherapy for esophageal varices.  Hepatology. 1990;  11 348-352
  • 2 Japanese Research Society for Portal Hypertension. The general rules for recording endoscopic findings on esophageal varices.  Jpn J Surg. 1980;  10 84-87
  • 3 Nakamura H, Shimojuu K, Inoue H, et al. Endoscopic ultrasonographic observation of esophageal varices and their collateral vessels during the non-shunting operation (in Japanese).  Gastroenterol Endosc. 1988;  30 2588-2594
  • 4 Caletti G C, Brocchi E, Barnara L, et al. Role of endoscopic ultrasonography in the treatment of esophageal varices.  Endoscopy. 1991;  23 284-285
  • 5 Matsumoto A, Hamamoto N, Ohnishi A, et al. Left gastric vein hemodynamics and variceal recurrence in patients undergoing prophylactic endoscopic ligation of high risk esophageal varices.  Gastrointest Endosc. 1999;  50 768-774
  • 6 Takashi M, Igarashi M, Hino S, et al. Esophageal varices: correlation of left gastric venography and endoscopy in patients with portal hypertension.  Radiology. 1985;  155 327-331
  • 7 Hashizume M, Kitano S, Yamaga H, et al. Angioarchitectual classification of esophageal varices and paraesophageal veins in selective left gastric venography.  Arch Surg. 1989;  124 961-966
  • 8 Lo G H, Liang H L, Chang C F, et al. The impact of endoscopic variceal ligation on the pressure of the portal venous system.  J Hepatol. 1996;  24 74-80

S. Hino,M.D. 

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