Endosonographic evaluation of the venous anatomy around the gastro-esophageal junction in patients with portal hypertension.
OBJECTIVE
Para-esophageal venous collaterals and perforating veins have recently been suspected to play an important role in the development of esophageal varices and their recurrence after initial obliteration in patients with portal hypertension. We undertook this study to look at the cross-sectional venous anatomy around the gastro-esophageal junction, with special attention to those venous structures, using the Endoscopic Ultrasound (EUS) in patients with different grades of esophageal varices.


METHODS
EUS examination was performed on the upper stomach, GE junction, and lower esophagus in 50 patients with liver cirrhosis, 20 of whom had small (grades 1 & 2) and 30 had large (grades 3 & 4) esophageal varices.


RESULTS
Esophageal varices could be detected in all the 30 (100%) patients with large, but in 9 (45%) of patients with small varices. Gastric Varices were detected significantly more often by EUS (33; 66%) compared with endoscopy (17; 34%, p < 0.005). The mean number (2.8 +/- 1.4 and 4.7 +/- 1.78, p < 0.0005) and size 3.41 +/- 0.57 and 5.98 +/- 1.66, p < 0.00001) of paraesophageal veins were higher in patients with large varices compared with those with small varices. When the lower 5 cm of the esophagus was scanned in patients with small and large varices, perforating veins connecting the para-esophageal and the submucosal veins (varices) could be identified in 3 (15%) and 21 (70%, p < 0.0005) of patients, respectively.


CONCLUSIONS
Perforating veins connecting the paraesophageal with the submucosal veins (varices) in the lower esophagus, demonstrated for the first time by EUS, may have an important role in the development of varices and in their recurrence after sclerotherapy.
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
G
G
Choudhuri
R K
RK
Dhiman
D K
DK
Agarwal
D000328:Adult; D003097:Collateral Circulation; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D004947:Esophagus / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011168:Portal System; D012008:Recurrence; D013270:Stomach / Q000098:blood supply* / Q000000981:diagnostic imaging