title: Role of para-esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis.
abstract: OBJECTIVE
  Para-esophageal collateral veins (para-ECV) are observed by endoscopic ultrasonography (EUS) in patients with portal hypertension. However, the role of para-ECV in the portal venous system is not clear. To verify the role of para-ECV in the portal venous system, we investigated the relationship between the development of para-ECV as determined by EUS, and the portal blood flow ratio (PBFR) as determined by liver scintigraphy using 99mTc-phytate.
  
  
  METHODS
  Eighteen patients who did not have fundal gastric varices were studied before the start of and after the completion of all endoscopic sclerotherapy sessions for esophageal varices. EUS was performed to observe veins around the esophagus, para-ECV and perforating veins. To quantify the degree of development of para-ECV, the cross-sectional area of each para-ECV observed by EUS was measured. The sum total of these areas was used as an index of development of para-ECV. The PBFR was calculated by liver scintigraphy using 99mTc-phytate. The correlation between the sum total cross-sectional area of para-ECV and PBFR was examined.
  
  
  RESULTS
  After all endoscopic injection sclerotherapy sessions, the total cross-sectional area of para-ECV was 29.32 (26.72) mm2 (mean (SD)) and the PBFR was 48.47 (17.87)% (mean (SD)). A significant correlation between them was noted after treatment (r = - 0.70, P < 0.01). Variceal recurrence was observed in three of the patients who had perforating veins connected with para-ECV, regardless of degree of the para-ECV.
  
  
  CONCLUSIONS
  The para-ECV are collaterals, which reflect the portal blood flow after endoscopic sclerotherapy. para-ECV without perforating veins were considered to be important collaterals after treatment.
authors.affiliation: Department of Internal Medicine 2, Fukushima Medical University School of Medicine, Fukushima, Japan. irisawa@fmu.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Irisawa
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Obara
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Ayako
authors.initials: A
authors.lastname: Saito
authors.forename: Hideo
authors.initials: H
authors.lastname: Shishido
authors.forename: Goro
authors.initials: G
authors.lastname: Shibukawa
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Takagi
authors.forename: Go
authors.initials: G
authors.lastname: Yamamoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Seino
authors.forename: Fumio
authors.initials: F
authors.lastname: Shishido
authors.forename: Reiji
authors.initials: R
authors.lastname: Kasukawa
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sato
mesh_terms: D000368:Aged; D003097:Collateral Circulation / Q000502:physiology*; D019160:Endosonography; D004947:Esophagus / Q000098:blood supply / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D007564:Japan / Q000453:epidemiology; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000000981:diagnostic imaging / Q000503:physiopathology; D015995:Prevalence; D011379:Prognosis; D011877:Radionuclide Imaging; D012008:Recurrence; D015911:Sclerotherapy; D013223:Statistics as Topic; D016896:Treatment Outcome