Evaluation of portosystemic collaterals by SPECT imaging after endoscopic variceal sclerotherapy: Usefulness for predicting recurrence

Bleeding from esophageal varices is a major cause of morbidity and mortalit y in cirrhotic patients. Identification of patients at high risk for bleedi ng is particularly important. The aim of this study was to determine whethe r detection of portosystemic collaterals by SPECT could predict the outcome of endoscopic injection sclerotherapy of esophageal varices and be useful for selecting appropriate therapy. Methods: Sixty-two patients with liver-c irrhosis who were considered at high risk of bleeding were treated with end oscopic injection sclerotherapy. Endoscopy was performed every 3 mo after t herapy or until bleeding occurred. Before and within 2 wk after therapy, to mographic images of intra-abdominal blood pool were constructed by SPECT. R esults: Before therapy, the following portosystemic collateral routes were observed: coronary veins in 53 (85.5%) of 62 patients, short gastric veins in 8 patients (12.9%), splenorenal shunts in 10 patients (16.1%), and parau mbilical veins in 6 patients (9.7%). Patients positive for imaging of coron ary veins were divided into 3 groups on the basis of changes in images afte r therapy: complete responders (n = 17), whose coronary vein images disappe ared completely; partial responders (n = 18), whose images became smaller; and nonresponders (n = 18), whose images did not change significantly befor e or after therapy. The rates of recurrence after endoscopic injection scle rotherapy until 6 mo in complete responders (4/17, 23.5%) and partial respo nders (7/18, 38.9%) were significantly less (P < 0.05) than that in nonresp onders (11/13, 84.6%). The rate of recurrence of esophageal varices until 6 mo in nonresponders treated with additional submucosal injection sclerothe rapy (1/5, 20.0%) was significantly less (P < 0.05) than that in nonrespond ers without additional submucosal injection sclerotherapy (11/13, 84.6%). C onclusion: Abdominal blood-pool SPECT, a noninvasive method, is useful for evaluating the therapeutic effectiveness of endoscopic sclerotherapy, for p redicting the recurrence of varices, and for selecting appropriate manageme nt after sclerotherapy.