ENDOSONOGRAPHIC EVALUATION OF THE VENOUS ANATOMY AROUND THE GASTROESOPHAGEAL JUNCTION IN PATIENTS WITH PORTAL-HYPERTENSION

Background/Aims: Para-esophageal venous collaterals and perforating ve ins have recently been suspected to play an important role in the deve lopment of esophageal varices and their recurrence after initial oblit eration in patients with portal hypertension. We undertook this study to look at the cross-sectional venous anatomy around the gastro-esopha geal junction, with special attention. to these venous structures, usi ng the Endoscopic Ultrasound (EUS) in patients with different grades o f esophageal varices. Material and Methods: EUS examination was perfor med on the upper stomach, GE junction,and lower esophagus in 50 patien ts with liver cirrhosis, 20 of whom had small (grades 1 & 2) and 30 ha d Large (grades 3 & 4) esophageal varices. Results: Esophageal varices could be detected in all the 30 (100%) patients with large, but in 9 (45%) of patients with small varices. Gastric Varices were detected si gnificantly more often by EUS (33; 66%) compared with endoscopy (17; 3 4%, p<0.005). The mean number (2.8+/-1.4 and 4.7+/-1.78, p<0.0005) and size (3.41+/-0.57 and 5.98+/-1.66, p<0.00001) of paraesophageal veins were higher in patients with large varices compared with those with s mall varices. When the lower 5 cm of the esophagus was scanned in pati ents with small and barge varices, perforating veins connecting the pa ra-esophageal and the submucosal veins (varices) could be identified i n 3(15%) and 21(70%,p<0.0005) of patients, respectively. Conclusion: P erforating veins connecting the paraesophageal with the submucosal vei ns (varices) in the lower esophagus, demonstrated for the first time b y EUS, may have an important role in the development of varices and in their recurrence after sclerotherapy.