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ABSTRACT: In patients with portal hypertension, early recurrence of esophageal varices often occurs following endoscopic variceal ligation therapy or ligation and injection-sclerotherapy combined treatment. To assess the recurrence risk following endoscopic treatment, this study investigated the association between recurrence-free time and severity of esophagogastric vascular structures before treatment as determined by endoscopic ultrasonography.
Sixty-three patients with esophageal varices at high bleeding risk were treated by endoscopic variceal ligation therapy or ligation and injection-sclerotherapy combined treatment. Before the treatment, conventional endoscopy and endoscopic ultrasonography with a 20-MHz catheter probe were performed. Submucosal, perforating and adventitial veins in the esophagus and gastric cardia were examined. According to the endoscopic ultrasonography findings, the vascular structures were classified into two grades: mild and severe. The relationships between the endoscopic ultrasonography grades and variceal recurrence-free time were analyzed by the Kaplan-Meyer method.
Patients with severe as opposed to mild grade perforating veins in the gastric cardia had a significantly shorter recurrence-free time (P < 0.05). Those with severe paracardial veins also had a significantly shorter recurrence-free time (P < 0.01).
Endoscopic ultrasonography analysis for gastric cardial vascular structures before endoscopic treatment can be useful to predict the recurrence of esophageal varices.
Journal of Gastroenterology and Hepatology 01/2006; 21(1 Pt 2):227-31. · 2.87 Impact Factor
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ABSTRACT: Endoscopic variceal ligation (EVL) therapy has been performed widely to treat or prevent variceal bleeding. We sought to examine the influence of EVL for esophageal varices on collateral vessels in the vicinity of gastric cardia.
In 42 patients with esophagogastric varices, conventional endoscopy and endoscopic ultrasonography with a 20-MHz probe (CUP-EUS) were performed before and at every 3 months after EVL for esophageal varices. By using conventional endoscopy, cardial variceal sizes were divided into 3 grades: F0, F1, and F2. The sizes of submucosal, perforating, and paracardial vessels at the cardia also were classified into 3 grades according to CUP-EUS findings.
Conventional endoscopy showed cardial varices in 33 (79%) patients before and 23 (55%) patients at 3 months after the treatment (P < 0.05). CUP EUS showed that 29 (69%) patients had severe grade cardial submucosal vessels before EVL, but only 13 (31%) patients did after the treatment (P < 0.01). Nineteen (45%) patients had severe grade cardial perforating vessels before EVL, but only 4 (10%) patients did after the treatment (P < 0.001). Furthermore, patients with severe grade residual submucosal or perforating vessels at the cardia had shorter recurrence-free times of esophageal varices (P < 0.01, 0.05, respectively).
Collateral vessels in the vicinity of gastric cardia were improved significantly after EVL, indicating that esophageal varices can be treated by EVL even though they connect with cardial varices. Furthermore, eradication of such collateral vessels by EVL may lead to longer recurrence-free status of esophageal varices.
Clinical Gastroenterology and Hepatology 06/2004; 2(5):400-4. · 5.63 Impact Factor
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ABSTRACT: This study assessed the risk of recurrence of esophageal varices by evaluating the severity of cardia vascular structures in patients with portal hypertension by EUS with a catheter US probe before endoscopic variceal ligation.
Thirty consecutive patients with esophageal varices at high risk for bleeding were studied. Simultaneous conventional endoscopy and EUS with a 20 MHz catheter US probe were performed before endoscopic variceal ligation. By catheter US probe EUS findings, vascular structures in the gastric cardia were classified into 2 grades, mild and severe, and the relationship between the catheter US probe EUS findings and the recurrence rate of esophageal varices was analyzed.
Catheter US probe EUS before endoscopic variceal ligation demonstrated cardial submucosal varices in all patients, whereas conventional endoscopy revealed cardial varices in only 21 patients (70.0%, NS). Patients with recurrent esophageal varices after endoscopic variceal ligation were more likely to have severe-grade perforating veins before treatment than those without recurrence (71.4% vs. 12.5%, p < 0.01). Patients with severe as opposed to mild-grade perforating veins before treatment had a significantly higher recurrence rate (90.9% vs. 21.0%, p < 0.01%).
Catheter US probe EUS findings for cardial vascular structures before treatment are useful for predicting the likelihood of recurrence of esophageal varices.
Gastrointestinal Endoscopy 02/2002; 55(2):197-203. · 4.88 Impact Factor
