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Endoscopy 2000; 32(8): 630-634
DOI: 10.1055/s-2000-9018
Original Article
Georg Thieme Verlag Stuttgart · New York

Endoscopic Ultrasonographic Study of the Azygos Vein Before and After Endoscopic Obliteration of Esophagogastric Varices by Injection Sclerotherapy

A. M. Kassem, Z. A. Salama, M. S. Zakaria, M. Hassaballah, M. S. Hunter
  • Department of Tropical Medicine and Gastrointestinal Endoscopy Unit, Kasr El-Aini Faculty of Medicine, Cairo University, Cairo, Egypt
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Publication History

Publication Date:
31 December 2000 (online)

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Background and Study Aims: The azygos vein plays an important role as a drainage system for the superior portosystemic collateral circulation in portal hypertensive patients. Endoscopic ultrasonography (EUS) and Doppler EUS allow the performance of hemodynamic studies of the azygos vein. In this study, we observed the changes in the azygos vein which occur with variceal obliteration by endoscopic injection sclerotherapy (EIS).

Patients and Methods: We recruited patients with portal hypertension and bleeding varices who were not on portal pressure-lowering agents and who were scheduled for the EIS program. EUS was performed in these patients to study the azygos vein at the start of EIS. The azygos vein diameter, maximal velocity (Vmax), and blood flow volume index (BFVI) were measured. After variceal obliteration and within 1 week, another EUS study of the azygos vein was carried out.

Results: Out of 40 patients recruited into the study variceal obliteration and EUS assessment of the azygos vein, within 1 week of obliteration, was achieved in 33 We noticed a significant increase in azygos vein diameter (P < 0.001) and BFVI (P = 0.001) following variceal obliteration. No significant change was observed in Vmax (P > 0.05). In one patient, marked caliber irregularities were observed in the azygos vein after variceal obliteration.

Conclusions: Using EUS and Doppler EUS, hemodynamic studies of the azygos vein blood flow can be performed, allowing the monitoring of the effects of EIS and variceal obliteration on the superior portosystemic collateral circulation. The clinical significance of the observed changes in azygos blood flow that occur with variceal obliteration should be investigated in further studies and correlated with short-term and long-term outcome.

References

  • 1 Bosch J, Groszmann RJ. Measurement of azygos venous blood flow by a continuous thermal dilution technique - an index of blood flow through gastroesophageal collaterals in cirrhosis.  Hepatology. 1984;  4 424-429
    CrossrefPubMedGoogle Scholar
  • 2 Calès P, Braillon A, Jiron I, Lebrec D. Superior portosystemic collateral circulation estimated by azygos blood flow in patients with cirrhosis.  J Hepatol. 1984;  1 37-46
    PubMedGoogle Scholar
  • 3 Sukigara M, Komazaki T, Ohata M, et al. Transesophageal real-time dimensional Doppler echography - a new method for the evaluation of azygos venous flow.  Gastrointest Endosc. 1988;  34 125-128
    PubMedGoogle Scholar
  • 4 Lomas DJ, Hayball MP, Jones DP, et al. Non-invasive measurement of azygos venous blood flow using magnetic resonance.  J Hepatol. 1995;  22 399-403
    CrossrefPubMedGoogle Scholar
  • 5 Nabeshima M, Moriyasu F, Nishikawa K, et al. Azygos venous blood flow: measurement with direct bolus imaging.  Radiology. 1995;  195 467-470
    PubMedGoogle Scholar
  • 6 Debatin J, Zahner B, Meyenberger C, et al. Azygos blood flow phase contrast quantitation in volunteers and patients with portal hypertension pre- and post- intrahepatic shunt placement.  Hepatology. 1996;  24 1109-1115
    PubMedGoogle Scholar
  • 7 Salama ZA, Kassem AM, Giovannini M, Hunter MS. Endoscopic ultrasonographic study of the azygos vein in patients with varices.  Endoscopy. 1997;  29 748-750
    PubMedGoogle Scholar
  • 8 Sukigara M, Shimoji K, Ohata M, et al. Effects of propranolol and nitroglycerin on cephalad collateral venous flow in patients with cirrhosis: Evaluation using transoesophageal real-time two-dimensional Doppler echography.  Am J Gastroenterol. 1988;  83 1248-1254
    PubMedGoogle Scholar
  • 9 Caletti GC, Brocchi E, Baraldini M, et al. Assessment of portal hypertension by endoscopic ultrasonography.  Gastrointest Endosc. 1990;  36 Suppl 27
    PubMedGoogle Scholar
  • 10 Urabe T, Yoneshima M, Oika Y, et al. Evaluation of esophagogastric varices with endoscopic ultrasonography.  Dig Endosc. 1990;  2 414-423
    PubMedGoogle Scholar
  • 11 Ziegler K, Gregor M, Zeitz T, et al. Evaluation of endosonography in sclerotherapy of esophageal varices.  Endoscopy. 1991;  23 247-250
    PubMedGoogle Scholar
  • 12 Boustière C, Dumas O, Jouffre C, et al. Endoscopic ultrasonography classification of gastric varices in patients with cirrhosis. Comparison with endoscopic findings.  J Hepatol. 1993;  19 268-272
    PubMedGoogle Scholar
  • 13 Pontes JM, Leitao MC, Portek FA, et al. Endoscopic ultrasonography in the treatment of esophageal varices by injection sclerotherapy and band ligation: do we need it?.  Eur J Gastroenterol Hepatol. 1995;  7 41-46
    PubMedGoogle Scholar
  • 14 Dhiman RK, Choudhuri G, Saraswat VA, et al. Role of paraesophageal collaterals and perforating veins on outcome of endoscopic sclerotherapy for esophageal varices: an endosonographic study.  Gut. 1996;  38 759-764
    PubMedGoogle Scholar
  • 15 Leung KS, Sung JY, Ahuja AT, et al. Large paraesophageal varices on endosonography predict recurrence of esophageal varices and rebleeding.  Gastroenterology. 1997;  122 1811-1816
    PubMedGoogle Scholar
  • 16 Burtin P, Calès P, Oberti F, et al. Endoscopic ultrasonographic signs of portal hypertension in cirrhosis.  Gastrointest Endosc. 1995;  44 257-261
    PubMedGoogle Scholar
  • 17 Dobashi Y, Nakamura H. Portal hypertension: influence on management.  Gastrointest Endosc Clin N Am. 1995;  5 667-674
    PubMedGoogle Scholar
  • 18 Kassem AM, Salama ZA, Rösch T. Endoscopic ultrasonography in portal hypertension.  Endoscopy. 1997;  29 399-406
    PubMedGoogle Scholar
  • 19 Lee YT, Sung JJY, Yung MY, et al. Use of color Doppler EUS in assessing azygos blood flow for patients with portal hypertension.  Gastrointest Endosc. 1999;  50 47-52
    PubMedGoogle Scholar
  • 20 Yokoyama M, Shijo H, Ota K, et al. Systemic hemodynamics and serum nitrate levels in patients undergoing endoscopic variceal ligation.  Hepatology. 1996;  24 (1) 47-52
    PubMedGoogle Scholar
  • 21 Sugano S, Yamamoto K, Takamura N, et al. Azygos venous blood flow while fasting, postprandially, and after endoscopic variceal ligation, measured by magnetic resonance imaging.  J Gastroenterol. 1999;  34 (3) 310-314
    CrossrefPubMedGoogle Scholar
  • 22 Yokoyama M, Shijo H, Ota K, et al. Effects of endoscopic variceal sclerotherapy on azygos vein blood flow and systemic haemodynamics.  J Gastroenterol Hepatol. 1996;  11 (8) 780-785
    PubMedGoogle Scholar
  • 23 Bourbon P, Zarski JP, Kitmacher P, et al. Influence of the sclerosing of esophageal varices on portal pressure and azygos venous blood flow.  Gastroenterol Clin Biol. 1990;  14 (3) 244-247
    PubMedGoogle Scholar
  • 24 Hashizume M, Kitano S, Sugimachi K, Sueishi K. Three dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension.  Hepatology. 1988;  8 1482-1487
    PubMedGoogle Scholar
  • 25 Lin CY, Lin PW, Tsai HM, et al. Influence of paraesophageal venous collaterals on efficacy of endoscopic sclerotherapy for esophageal varices.  Hepatology. 1993;  19 602-608
    PubMedGoogle Scholar
  • 26 Dilawari JB, Raju GS, Chawla YK. Development of large spleno-adrenal-renal shunt after endoscopic sclerotherapy.  Gastroenterology. 1989;  97 421-426
    PubMedGoogle Scholar

M.Sc. B.Ch. M.B. KassemA. M. 

Dept. of Tropical Medicine and Gastrointestinal Endoscopy Unit Kasr El-Aini Faculty of MedicineCairo University

13, Ahmed Abdelaziz Str.

Agouza

Cairo

Egypt

Phone: +20-2-3037096

Email: kassem@mx.global.de

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