Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities: severe peri-esophageal collateral veins and large perforating veins

Background: Endoscopic ultrasonography (EUS) with a 20 MHz ultrasound (US) catheter probe can clearly demonstrate esophageal collateral veins. The pre sence of large peri-esophageal collateral veins has been correlated with la rge esophageal varices in patients with portal hypertension. The correlatio n between the size of esophageal collateral veins and endoscopic recurrence of esophageal varices in patients with portal hypertension who had undergo ne endoscopic injection sclerotherapy was investigated. Furthermore, whethe r EUS findings could predict the variceal recurrence was retrospectively st udied. Methods: Thirty-eight patients who had undergone endoscopic injection scler otherapy were examined every 3 to 4 months with endoscopy and US catheter p robe for a period of 2 years. Recurrence of esophageal varices was determin ed by endoscopic findings of either new varix formation or appearance of re d color sign. Esophageal collateral veins were identified by US catheter pr obe As peri-esophageal collateral veins (adjacent to the esophageal wall) a nd para-esophageal collateral veins (separated from the esophageal wall) al ong with perforating veins; and they were graded as severe and mild type by US catheter probe. Result. Ten of the 38 patients (26.3%) had endoscopic recurrence at a mean of 10.9 months after endoscopic injection sclerotherapy. In patients with e ndoscopic recurrences, EUS findings included a significantly (p < 0.001) hi gher incidence of severe type peri-esophageal collateral veins, a significa ntly larger number of perforating veins (p < 0.001) and a significantly lar ger diameter of perforating veins (p < 0.001) compared with patients withou t recurrence (8 of 10, 80% vs. 2 of 28, 7.1%; 1.30 vs. 0.21; 2.00 vs. 0.32 mm, respectively). The presence of veins at the esophagogastric junction di d not correlate with recurrence. Conclusion: Severe type peri-esophageal collateral veins and large perforat ing veins of the esophagus detected by EUS in patients treated by endoscopi c injection sclerotherapy signify recurrence of esophageal varices and pred ict endoscopic recurrence of varices in subsequent months.