title: Left gastric vein hemodynamics and variceal recurrence in patients undergoing prophylactic endoscopic ligation of high-risk esophageal varices.
abstract: BACKGROUND
  Early recurrence of esophageal varices remains problematic after endoscopic variceal ligation. To evaluate the efficacy of prophylactic endoscopic ligation for esophageal varices at high risk for bleeding, the relationship between left gastric vein hemodynamics and variceal recurrence was investigated.
  
  
  METHODS
  Thirty-five patients with cirrhosis underwent endoscopic variceal ligation. Angiography was performed in all patients before treatment and after eradication of varices to study left gastric vein hemodynamics.
  
  
  RESULTS
  Before treatment, 12 patients had hepatopetal flow in the left gastric vein (type I), 17 had hepatofugal flow (type II), and 6 had hepatofugal flow with an extra-esophageal shunt (type III). In type I and III patients, the direction of blood flow in the left gastric vein did not change after eradication of varices. Type II patients showed bi-directional flow in the left gastric vein after treatment. Varices recurred in all but one type II patient and in one type I patient during follow-up (mean 36.7 months). The 2-year recurrence-free rate was higher in type I patients (p = 0.0001) and type III patients (p = 0.0002) than in type II patients.
  
  
  CONCLUSIONS
  Prophylactic ligation seems to be a safe and useful procedure, especially in patients with type I or III hemodynamics in the left gastric vein before treatment.
authors.affiliation: Second Department of Internal Medicine, Osaka Medical College, Takatsuki, Osaka, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Matsumoto
authors.forename: N
authors.initials: N
authors.lastname: Hamamoto
authors.forename: A
authors.initials: A
authors.lastname: Ohnishi
authors.forename: H
authors.initials: H
authors.lastname: Miyoshi
authors.forename: K
authors.initials: K
authors.lastname: Sugi
authors.forename: H
authors.initials: H
authors.lastname: Kojima
authors.forename: M
authors.initials: M
authors.lastname: Kayazawa
authors.forename: H
authors.initials: H
authors.lastname: Morikawa
authors.forename: I
authors.initials: I
authors.lastname: Hirata
authors.forename: K
authors.initials: K
authors.lastname: Katsu
mesh_terms: D015901:Angiography, Digital Subtraction; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005753:Gastric Mucosa / Q000098:blood supply; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D005773:Gastroscopy; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D012008:Recurrence; D012307:Risk Factors; D013270:Stomach / Q000098:blood supply*