A PILOT-STUDY ON MODIFIED ENDOSCOPIC VARICEAL LIGATION USING ENDOSCOPIC ULTRASONOGRAPHY WITH COLOR DOPPLER FUNCTION

Objective: The purpose of the study was to evaluate feasibility of mod ified endoscopic variceal ligation (EVL), namely the ''intensive ligat ion'' method, using endoscopic ultrasonography with color Doppler func tion (EUS-CD). Methods: Forty-five patients with esophageal varices we re treated by modified EVL. Variceal hemodynamics in 38 patients were examined using EUS-CD, which showed abdominal hemodynamics in detail u nder physiological renditions before and after the modified procedure, Results: 1) The median number of treatment sessions was 3.2, and 41 O -rings on average were required per individual patient. 2) The median nonrecurrence period after treatment was 18 months (Kaplan-Meier metho d), 3) Nine patients with a good response tea modified EVL did not hav e recurrences for 16.9 +/- 2.8 months, and five with a poor response h ad recurrences at 5.8 +/- 2.2 months, Gastric varices were related to the response to modified EVL (p < 0.05, Mann-Whitney's U test), 4) Min or complications ire modified EVL, as well as standard EVL were experi enced; however, we had a patient with the development of meningitis, w hich was a major septic complication, 5) Before modified EVL, EUS-CD d emonstrated that good responders had undeveloped (grade I) gastric var ices in flue of nine (56%); however, poor responders had developed (gr ade III) gastric varices in four of five (80%) (p < 0.05, Mann-Whitney 's U test], 6) After modified EVL, EUS-CD revealed that six of nine (6 7%) good responders and one of five (20%) poor responders showed a dec rease in color signals in supplying veins; however, none of the former (0%) and three of the latter (60%) showed art increase (p < 0.05, Man n-Whitney's U test], Conclusion: Modified EVL was safe and effective, at least with regard to intermediate-term outcome, especially when tre ating patients with undeveloped gastric varices revealed by EUSCD, Bot h goad and poor responders showed no exacerbation of gastric varices a fter the modified procedure, ultrasonographically as well as endoscopi cally. (C) 1998 by Am, Coil, of Gastroenterology).