Hemodynamic assessment of the left gastric vein in patients with esophageal varices with color Doppler EUS: factors affecting development of esophageal varices.
BACKGROUND
An understanding of the development of esophageal varices is important in the evaluation of risk of variceal hemorrhage. To clarify factors affecting the development of esophageal varices, the morphology and hemodynamics of the left gastric vein were analyzed with color Doppler EUS.


METHODS
Sixty-seven patients with esophageal varices underwent color Doppler EUS. Seventeen had small varices (F1), 32 had medium varices (F2), and 18 had large varices (F3).


RESULTS
Hepatofugal blood flow velocity in the left gastric vein trunk increased as the size of the varices increased (p < 0.0001), whereas the diameter did not increase. The left gastric vein bifurcates into anterior and posterior branches. As the size of the varices enlarged, the branch pattern was more likely to be anterior branch dominant (p = 0.041). There was no significant difference between the 3 size groups of esophageal varices with respect to the size of the paraesophageal collaterals. The detection rate and diameter of the perforating vein increased as the size of the varices increased (p = 0.032 and 0.012, respectively).


CONCLUSIONS
Blood flow velocity in the left gastric vein trunk, branches, and perforating veins may regulate blood flow supplying the esophageal varices and contribute to their development. These findings are important to understanding the pathogenesis of esophageal varices.
Hino
Shoryoku
S
Department of Endoscopy, Jikei University School of Medicine, Tokyo, Japan.
Kakutani
Hiroshi
H
Ikeda
Keiichi
K
Uchiyama
Yujiro
Y
Sumiyama
Kazuki
K
Kuramochi
Akira
A
Kitamura
Yoko
Y
Matsuda
Koji
K
Arakawa
Hiroshi
H
Kawamura
Muneo
M
Masuda
Katsunori
K
Suzuki
Hiroaki
H
D000328:Adult; D000368:Aged; D003097:Collateral Circulation; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004947:Esophagus / Q000098:blood supply*; D005260:Female; D006439:Hemodynamics; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D012039:Regional Blood Flow; D013152:Splanchnic Circulation; D018608:Ultrasonography, Doppler