title: How do we select an endoscopic treatment for esophageal varices on the basis of hemodynamic analysis using color Doppler endoscopic ultrasonography.
abstract: We investigated the hemodynamics of the left gastric vein (LGV) and its association with variceal recurrence using color Doppler endoscopic ultrasonography (CD-EUS). The long-term results of our technique known as combined ligation and sclerotherapy showed that the risk of variceal recurrence decreased after long-term follow-up with timely repeated therapies. On the basis of the hemodynamic background of these results, it was suggested that the posterior branch of the LGV could have developed as an extravariceal shunt, whereas the anterior branch, which directly feeds varices, seemed to disappear through long-term follow-up with repeated treatments. In the study comparing CD-EUS findings between patients with and without variceal recurrence, dominance between anterior and posterior branches and the hepatofugal flow velocity of the LGV were suggested to be important factors contributing to variceal recurrence. We consider that these patients may require more intense therapy, such as the mucofibrosing technique or a technique to obliterate both the varices and their donor vessels.
authors.affiliation: Department of Endoscopy, Division of Hepatology and Gastroenterology, The Jikei University School of Medicine, Tokyo, Japan. endosc-kaku@jikei.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kakutani
authors.forename: Syoryoku
authors.initials: S
authors.lastname: Hino
authors.forename: Seita
authors.initials: S
authors.lastname: Koyama
authors.forename: Yujiro
authors.initials: Y
authors.lastname: Uchiyama
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
authors.forename: Hiroo
authors.initials: H
authors.lastname: Imazu
authors.forename: Muneo
authors.initials: M
authors.lastname: Kawamura
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000628:therapy*; D004947:Esophagus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008026:Ligation / Q000379:methods; D015911:Sclerotherapy; D018615:Ultrasonography, Doppler, Color / Q000379:methods*