Upper gastrointestinal endosonography in patients evaluated for liver transplantation.
BACKGROUND
Endosonography (EUS), which merges endoscopic and ultrasound examinations, is a useful modality to display abnormal vessels that develop in the intrinsic circulation, frequently called "deep" varices. If these pathological veins exceed of 5 mm diameter, they significantly increase the risk of bleeding among patients with cirrhosis. In the most recent pilot study EUS proved useful to assess children for orthotopic liver transplantation (OLT).


OBJECTIVE
We performed a cross-sectional study of EUS on 33 (22 males and 11 females) adult cirrhotic subjects being assessed for OLT.


METHODS
We used an echoendoscope at 7.5 MHz/12 MHz/20 MHz to evaluate the esophagus and stomach, including "deep" periesophageal/perigastric varices (adjacent to the muscularis propria) and paraesophageal/paragastric varices (outside the muscularis propria). "Deep" varices were considered to be large if >5 mm.


RESULTS
On endoscopy, 26 (79%) patients showed esophageal varices (EV), including 11 (33%) with large (>5 mm) varices. Gastric varices (GV) were observed in 13 (39%) subjects, with 3 patients displaying large (>5 mm) varices. On EUS large "deep" EV (both para and periesophageal) were observed in 12 (36%) subjects, among whom 5 (42%) did not have large varices on endoscopy. Large "deep" GV were found on EUS in 12 (36%) subjects. On endoscopy 4 of them (33%) showed no varices and 3 (25%) had small GV.


CONCLUSIONS
EUS offers a precise evaluation of portal hypertension in OLT candidates. "Deep" potentially dangerous varices, which are undetected with routine endoscopy, were noted in a significant proportion of patients. The role of EUS in prioritizing subjects for OLT must be evaluated in a prospective study.
Department of Endoscopy, Ministry of Internal Affairs Hospital, Szczecin, Poland.
A
A
Wiechowska-Kozlowska
J
J
Raszeja-Wyszomirska
M P
MP
Wasilewicz
A
A
Bialek
E
E
Wunsch
M
M
Wójcicki
P
P
Milkiewicz
D000328:Adult; D002648:Child; D003430:Cross-Sectional Studies; D019160:Endosonography / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000000981:diagnostic imaging; D041742:Upper Gastrointestinal Tract / Q000000981:diagnostic imaging* / Q000601:surgery