EUS changes predictive for recurrence of esophageal varices in patients treated by combined endoscopic ligation and sclerotherapy

Background: Recurrence of varices is still common after endoscopic treatmen t of esophageal varices. In this study, predictive signs of variceal recurr ence were investigated by ultrasonic (US) miniature probe in patients treat ed by combined endoscopic ligation and sclerotherapy. Methods: Detectability of vessels by US miniature probe was evaluated first in rats. In 41 patients treated by combined therapy, the esophagus and the cardia region were examined by US miniature probe. In 25 patients examined by percutaneous transhepatic portography, the relationship between US mini ature probe and percutaneous transhepatic portography findings was evaluate d. Results: The smallest vessel detected by US miniature probe was 0.3 mm in d iameter in the study using intra-abdominal vessels of rat. After variceal e radication, US miniature probe showed intramural vessels in the cardia that were classified as follows: grade I, a few vessels (19 patients, 46%); gra de II, uniformly scattered vessels (11,27%); grade III, abundant vessels re sembling a honeycomb (11,27%). As the sonographic grade increased, the rate of variceal recurrence increased. As the venographic grade of staining in the distal esophagus increased, the esophageal wall became thicker and the sonographic grade at the cardia increased. Conclusions: Endosonographic evaluation of the distal esophagus and cardia is predictive of variceal recurrence.