T. Suzuki et al., EUS changes predictive for recurrence of esophageal varices in patients treated by combined endoscopic ligation and sclerotherapy, GASTROIN EN, 52(5), 2000, pp. 611-617
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.