Study of hemodynamic changes in portal systemic shunts and their relation to variceal relapse after endoscopic variceal ligation combined with ethanol sclerotherapy.
BACKGROUND
Among the factors influencing variceal relapse after endoscopic treatment, portal hemodynamic changes, especially in portal systemic shunts, could be the most important factor because hemodynamics are directly related to the development of esophageal varices. We aimed to clarify the influence of endoscopic treatment for esophageal varices on portal systemic shunts as well as its predictive value for variceal relapse.


METHODS
Fifty patients who underwent combined endoscopic variceal ligation and injection sclerotherapy were examined with sonography and portography.


RESULTS
Decrease of diameter, hepatopetal flow direction in the left gastric vein, or the presence of non-varices portal systemic shunt were sonographic findings related to a low incidence of variceal relapse. The presence of blood flow in and around the esophagus on venograms was highly predictive for variceal relapse. In patients with such venograms, non-varices portal systemic shunts did not develop.


CONCLUSIONS
Sonographic assessment of hemodynamic changes in portal systemic shunt could be useful for estimating the results of endoscopic treatment for esophageal varices.
Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
Kenji
K
Ito
Shoichi
S
Matsutani
Hitoshi
H
Maruyama
Taro
T
Akiike
Hiromasa
H
Nomoto
Toshiya
T
Suzuki
Takeshi
T
Fukuzawa
Hideaki
H
Mizumoto
Hiromitsu
H
Saisho
D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D004945:Esophagoscopy; D004947:Esophagus / Q000098:blood supply*; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011172:Portography; D012008:Recurrence; D015911:Sclerotherapy; D014463:Ultrasonography
D000431:Ethanol