Hemodynamic analysis of esophageal varices using color Doppler endoscopic ultrasonography to predict recurrence after endoscopic treatment.
OBJECTIVE
The time to recurrence of esophageal varices may vary greatly between patients even after the same endoscopic therapy. To clarify the factors which contribute to recurrence after endoscopic treatment, the hemodynamics and morphology of the left gastric vein (LGV) were investigated using color Doppler endoscopic ultrasonography (EUS).


METHODS
A total of 31 patients with high-risk esophageal varices underwent color Doppler-EUS before receiving endoscopic variceal ligation and endoscopic injection sclerotherapy combined therapy. Endoscopic examination was performed every 3 months after the treatment to evaluate recurrence of varices.


RESULTS
A total of 18 patients responded to the therapy, while 13 patients did not respond, and had recurrence within 12 months. The hepatofugal flow velocity in the LGV trunk was significantly lower in the responders (9.9 vs. 13.9 cm/sec; P = 0.02). The branch pattern of the LGV was categorized into three groups: anterior branch dominant, posterior branch dominant, and no-dominant type. The incidence of the anterior branch dominant type was significantly less in responders (17 vs. 70 %; P = 0.01). There was no significant difference in the LGV trunk diameter and the size of the paraesophageal vein between the two groups.


CONCLUSIONS
Risk factors for recurrence can be analyzed in detail using color Doppler-EUS. Further investigation using color Doppler-EUS may enable us to select the optimal way to treat esophageal varices to prevent recurrence.
Hino
S
S
Department of Endoscopy, Jikei University School of Medicine, Tokyo, Japan. shoryok@attglobal.net
Kakutani
H
H
Ikeda
K
K
Yasue
H
H
Kitamura
Y
Y
Sumiyama
K
K
Uchiyama
Y
Y
Kuramochi
A
A
Matsuda
K
K
Arakawa
H
H
Hachiya
K
K
Kawamura
M
M
Masuda
K
K
Suzuki
H
H
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D016145:Endoscopy, Digestive System / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D004947:Esophagus / Q000098:blood supply; D005260:Female; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging*; D015911:Sclerotherapy / Q000379:methods; D055502:Secondary Prevention; D018615:Ultrasonography, Doppler, Color / Q000379:methods*