Background and Study Aims : Balloon-occluded retrograde transvenous obliteration (B-RTO) has emerged as an effective,
minimally invasive treatment for fundal varices. B-RTO requires a spontaneously developed
gastrorenal shunt as a pathway for the balloon catheter to reach the fundal varices.
We used a curved linear-array (CLA) echo endoscope in patients with fundal varices
to identify gastrorenal shunts, and compared the detection rate with the gold standard,
contrast-enhanced computed tomography (CECT).
Patients and Methods : A total of 40 patients with fundal varices were examined with both CLA echo endoscopy
and CECT. The CECT images were retrospectively and independently evaluated by two
gastroenterologists who were unaware of the clinical details, including the results
of the CLA echo endoscopy.
Results : CLA echo endoscopy identified gastrorenal shunts in 26/40 patients with fundal varices.
It visualized the shunt in a longitudinal direction and provided images of the connections
of the shunt at both ends, the fundal varices and the left renal vein/branch of the
inferior adrenal vein. The kappa index for CLA echo endoscopy and CECT for the identification
of gastrorenal shunt was 0.9 (95 % CI, 0.6 to 1.0). When the cutoff point for the
diameter of the gastrorenal shunt detected by the CLA echo endoscope was set at equal
to or greater than 5 mm, the kappa index was 1.0 (95 % CI, 0.7 to 1.0).
Conclusions : These results suggest that CLA echo endoscopy can successfully identify gastrorenal
shunt and provide detailed morphological information. It also efficiently identifies
patients suitable for B-RTO, particularly in cases of acute bleeding. It also has
considerable potential for providing detailed information with regard to the treatment
of gastric varices.
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H. Kakutani, M.D.
Department of Endoscopy · Jikei University School of Medicine
Nishi-shimbashi 3-25-8, Minato-ku · Tokyo · Japan, 105-8461
Fax: + 81-3-3459-4524
eMail: endosc-kaku@jikei.ac.jp