Endoscopic ultrasonograph evaluation of vascular structures in the gastric cardia predicts esophageal variceal recurrence following endoscopic treatment.
OBJECTIVE
In patients with portal hypertension, early recurrence of esophageal varices often occurs following endoscopic variceal ligation therapy or ligation and injection-sclerotherapy combined treatment. To assess the recurrence risk following endoscopic treatment, this study investigated the association between recurrence-free time and severity of esophagogastric vascular structures before treatment as determined by endoscopic ultrasonography.


METHODS
Sixty-three patients with esophageal varices at high bleeding risk were treated by endoscopic variceal ligation therapy or ligation and injection-sclerotherapy combined treatment. Before the treatment, conventional endoscopy and endoscopic ultrasonography with a 20-MHz catheter probe were performed. Submucosal, perforating and adventitial veins in the esophagus and gastric cardia were examined. According to the endoscopic ultrasonography findings, the vascular structures were classified into two grades: mild and severe. The relationships between the endoscopic ultrasonography grades and variceal recurrence-free time were analyzed by the Kaplan-Meyer method.


RESULTS
Patients with severe as opposed to mild grade perforating veins in the gastric cardia had a significantly shorter recurrence-free time (P < 0.05). Those with severe paracardial veins also had a significantly shorter recurrence-free time (P < 0.01).


CONCLUSIONS
Endoscopic ultrasonography analysis for gastric cardial vascular structures before endoscopic treatment can be useful to predict the recurrence of esophageal varices.
Seno
Hiroshi
H
Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan. seno@kuhp.kyoto-u.ac.jp
Konishi
Yasuhiro
Y
Wada
Manabu
M
Fukui
Hirokazu
H
Okazaki
Kazuichi
K
Chiba
Tsutomu
T
D000368:Aged; D002299:Cardia / Q000098:blood supply* / Q000000981:diagnostic imaging; D004724:Endoscopy; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000601:surgery*; D004947:Esophagus / Q000098:blood supply / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015911:Sclerotherapy; D018615:Ultrasonography, Doppler, Color