Evaluation of arterial blood flow in esophageal varices via endoscopic color Doppler ultrasonography with a galactose-based contrast agent.
BACKGROUND
We examined the usefulness of endoscopic color Doppler ultrasonography, using Levovist in evaluating the arterial blood flow, in patients with esophageal varices.


METHODS
The study involved 110 patients with esophageal varices who were examined using endoscopic color Doppler ultrasonography (ECDUS). We compared vessel images detected by pre-contrast ECDUS with those detected by enhanced ECDUS. We evaluated the detection rate of the pulsatile wave, and measured systolic velocity and end-diastolic velocity. We calculated the resistance index (RI), which demonstrates the resistance of peripheral vessels in arterial flow.


RESULTS
Color flow images of the pulsatile wave were obtained by pre-contrast ECDUS in 3 (2.7%) of the 110 patients. Color flow images of the pulsatile waves were obtained in 40 (36.4%) of the 110 patients by enhanced ECDUS using Levovist. That is, by using Levovist, a pulsatile wave could be delineated in 37 patients in whom pulsatile waves were previously undiagnosed via pre-contrast ECDUS. Color flow images of the pulsatile waves were detected in 37 (37.7%) of the 98 F2 varices and in 3 (25.0%) of the 12 F3 varices. Color flow images of the pulsatile wave were detected in 35 (40.2%) of the 87 red color (RC)(+) varices, and in 5 (21.7%) of the 23 RC(++) or RC (+++) varices. Next, we calculated the RI of the pulsatile wave, obtained by enhanced ECDUS using Levovist, in 40 patients. The RI ranged from 0.49 to 0.83 (mean, 0.67 +/- 0.09); there were nine patients with RIs of less than 0.60, and all 9 of these patients had both F2 and RC(+) type varices (100%).


CONCLUSIONS
Levovist contrast in ECDUS examinations suggests that arterial flow is involved in the formation of esophageal varices.
Sato
Takahiro
T
Department of Gastroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo 060-0033, Japan.
Yamazaki
Katsu
K
Toyota
Jouji
J
Karino
Yoshiyasu
Y
Ohmura
Takumi
T
Akaike
Jun
J
Kuwata
Yasuaki
Y
Suga
Toshihiro
T
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D003097:Collateral Circulation / Q000502:physiology; D003287:Contrast Media / Q000008:administration & dosage*; D003971:Diastole / Q000502:physiology; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004947:Esophagus / Q000098:blood supply / Q000000981:diagnostic imaging; D005260:Female; D005690:Galactose / Q000008:administration & dosage*; D006801:Humans; D007564:Japan; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D013599:Systole / Q000502:physiology; D018615:Ultrasonography, Doppler, Color
D003287:Contrast Media; D005690:Galactose