ROLE OF PARAESOPHAGEAL COLLATERALS AND PERFORATING VEINS ON OUTCOME OF ENDOSCOPIC SCLEROTHERAPY FOR ESOPHAGEAL-VARICES - AN ENDOSONOGRAPHICSTUDY

Background-Endoscopic sclerotherapy (EST) is an established method for controlling and preventing bleeding from oesophageal varices. However , oesophageal varices sclerose easily and require less sessions of EST in some patients while few fail to respond. This study therefore look ed at changes in the vascular anatomy of the lower oesophagus and uppe r stomach that accompany successful sclerotherapy of oesophageal varic es. Methods-Endoscopic ultrasonography was performed in 50 patients wi th cirrhotic portal hypertension before (control, 20 patients) and aft er successful obliteration of varices with endoscopic sclerotherapy in a group of responders (EST-R, 20 patients) and in a group of non-resp onders (EST-NR, 10 patients). Results-The median number and size of su bmucosal veins at the gastrooesophageal junction and in the lower oeso phagus were significantly less in the EST-R group compared with contro l and EST-NR groups (p values between <0.00001 and <0.000001). Concomi tantly, the number and size of paraoesophageal collaterals were signif icantly less in the EST-R group compared with the other two groups (p values between 0.02 and 0.00007). Perforating veins were identified in 14 (70%) patients in the control group, nine (90%) in the EST-NR grou p and in none in the EST-R group (p<0.001 for both controls v EST-R an d EST-R v EST-NR, and p=NS, control v EST-NR). Conclusion-Oesophageal variceal sclerosis is associated with significant reduction in the num ber and size of paraoesophageal collaterals and disappearance of perfo rating veins in the lower oesophagus.