Elsevier

Gastrointestinal Endoscopy

Volume 55, Issue 2, February 2002, Pages 197-203
Gastrointestinal Endoscopy

Original Articles
Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence

https://doi.org/10.1067/mge.2002.121338Get rights and content

Abstract

Background: This study assessed the risk of recurrence of esophageal varices by evaluating the severity of cardia vascular structures in patients with portal hypertension by EUS with a catheter US probe before endoscopic variceal ligation. Methods: Thirty consecutive patients with esophageal varices at high risk for bleeding were studied. Simultaneous conventional endoscopy and EUS with a 20 MHz catheter US probe were performed before endoscopic variceal ligation. By catheter US probe EUS findings, vascular structures in the gastric cardia were classified into 2 grades, mild and severe, and the relationship between the catheter US probe EUS findings and the recurrence rate of esophageal varices was analyzed. Results: Catheter US probe EUS before endoscopic variceal ligation demonstrated cardial submucosal varices in all patients, whereas conventional endoscopy revealed cardial varices in only 21 patients (70.0%, NS). Patients with recurrent esophageal varices after endoscopic variceal ligation were more likely to have severe-grade perforating veins before treatment than those without recurrence (71.4% vs. 12.5%, p < 0.01). Patients with severe as opposed to mild-grade perforating veins before treatment had a significantly higher recurrence rate (90.9% vs. 21.0%, p < 0.01%). Conclusions: Catheter US probe EUS findings for cardial vascular structures before treatment are useful for predicting the likelihood of recurrence of esophageal varices. (Gastrointest Endosc 2002;55:197-203.)

Section snippets

Patients and methods

Thirty consecutive patients (20 men, 10 women; median age 56 years; interquartile range [IQR] 51-64 years) with high-risk esophageal varices were studied between October 1996 and April 2000. Varices in all patients exhibited severe red color signs, which are believed to indicate a high risk for variceal rupture.10 Seven patients had a history of endoscopically proven variceal bleeding that had been treated by balloon tamponade alone. Patients who had undergone emergent endoscopic treatments to

Results

Recurrence of esophageal varices was detected endoscopically in 14 of the 30 patients (46.7%) within 3 months after EVL. There was no statistically significant difference in any of the clinical characteristics between the recurrent and nonrecurrent groups except for age and the proportion of patients with a history of variceal hemorrhage (Table 2).

. Clinical characteristics of patients with and without recurrence of esophageal varices

Empty CellTotal (n = 30)Nonrecurrent group (n = 16)Recurrent group (n =

Discussion

Calletti et al.1 were the first to report the usefulness of conventional EUS for evaluation of esophagogastric varices in patients with portal hypertension. These investigators reported that EUS with a 7.5-MHz transducer was superior to conventional endoscopy for detecting varices in the fundus of the stomach, and that there was a direct correlation between the endoscopic grade of the esophageal varices and the diameter of the paraesophageal collaterals on EUS. The 7.5-MHz probe is especially

Acknowledgements

We are grateful to Dr. Hajiro K, MD (Tenri hospital, Nara, Japan) and Dr. Kajiyama T, ND (Kansai Denryoku hospital, Osaka, Japan) for editorial assistance in the preparation of this manuscript.

References (17)

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Reprint requests: Yasuhiro Konishi, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Rawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.

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