EUS changes predictive for recurrence of esophageal varices in patients treated by combined endoscopic ligation and sclerotherapy

• Published in: Gastrointestinal endoscopy Vol. 52; no. 5; pp. 611 - 617
• Main Authors: Suzuki, Toshiya, Matsutani, Shoichi, Umebara, Keiji, Sato, Goro, Maruyama, Hitoshi, Mitsuhashi, Osamu, Nakano, Yoko, Fukamachi, Tadahiro, Saisho, Hiromitsu
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2000; Elsevier
• Subjects: Adult; Aged; Animals; Biological and medical sciences; Combined Modality Therapy; Endosonography; Esophageal and Gastric Varices - diagnostic imaging; Esophageal and Gastric Varices - therapy; Esophagoscopy; Esophagus; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Ligation; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Predictive Value of Tests; Radiography; Rats; Rats, Wistar; Recurrence; Sclerotherapy; Sonography; Human; Endoscopic surgery; Relapse; Portal circulation disease; Esophageal disease; Cardiovascular disease; Sclerotherapy; Venous disease; Esophagus; Esophagoscopy; Vascular disease; Chemotherapy; Ligature; Treatment; Echography; Digestive diseases; Endoscopy; Predictive factor; Varix
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1067/mge.2000.109801

Background: Recurrence of varices is still common after endoscopic treatment of esophageal varices. In this study, predictive signs of variceal recurrence were investigated by ultrasonic (US) miniature probe in patients treated by combined endoscopic ligation and sclerotherapy. Methods: Detectability of vessels by US miniature probe was evaluated first in rats. In 41 patients treated by combined therapy, the esophagus and the cardia region were examined by US miniature probe. In 25 patients examined by percutaneous transhepatic portography, the relationship between US miniature probe and percutaneous transhepatic portography findings was evaluated. Results: The smallest vessel detected by US miniature probe was 0.3 mm in diameter in the study using intra-abdominal vessels of rat. After variceal eradication, US miniature probe showed intramural vessels in the cardia that were classified as follows: grade I, a few vessels (19 patients, 46%); grade II, uniformly scattered vessels (11, 27%); grade III, abundant vessels resembling a honeycomb (11, 27%). As the sonographic grade increased, the rate of variceal recurrence increased. As the venographic grade of staining in the distal esophagus increased, the esophageal wall became thicker and the sonographic grade at the cardia increased. Conclusions: Endosonographic evaluation of the distal esophagus and cardia is predictive of variceal recurrence. (Gastrointest Endosc 2000;52:611-7.)