Blood supply routes of recurrent esophageal varices following endoscopic embolization

Background/Aim: The blood supply routes of recurrent esophageal varices fol lowing complete endoscopic embolization (EE) are not yet known. The purpose of this study is to identify these blood supply routes by comparing endosc opic varicography and percutaneous transhepatic portography (PTP). Methods: Eleven cases of recurrent esophageal varices following EE are included in this study. The blood supply routes of primary and recurrent varices were a nalyzed by comparing the varicography obtained at the initial and repeat EE with PTPs before and after the initial EE. Results: Endoscopic varicograph y at the time of initial EE could show the vessels of the left gastric vein (LGV) system, such as the cardiac branch of the LGV, and the cardiac venou s plexus (CP) in 100% of cases, and the trunk of the LGV in 73% (8/11) of c ases, whereas the posterior gastric vein was seen in only 18% (2/11) of cas es. PIP performed 2 weeks after the initial EE confirmed that the routes vi sualized by endoscopic varicography could be obliterated in 10 of 11 cases. The blood supply routes of recurrent varices, demonstrated by varicography , were the vessels of the short gastric vein (SGV) system, such as the fund ic branch of the SGV or the posterior gastric vein in 82% (9/11) of cases, and the partially reformed fine CP in 27% (3/11) of cases. Varicography rev ealed the remnant vessels of the LGV in only 1 case. Conclusions: The prima ry esophageal varices are supplied with blood mainly from the cardiac branc h of the LGV through the CP. However, the blood supplies of recurrent varic es following EE come from the fundic branch of the SGV or the posterior gas tric vein. We conclude that three-dimensional obliteration of esophageal va rices and their feeders, the LGV and SGV systems, is completed by initial a nd repeat EEs. Copyright (C) 2000 S. Karger AG. Basel.