title: Three-dimensional computed tomography of portopulmonary venous anastomoses in patients with esophageal varices before treatment.
abstract: OBJECTIVE
  Portopulmonary venous anastomoses (PPVA) are shunts between esophageal varices and pulmonary veins. Because PPVA can cause serious complications at the time of sclerotherapy for esophageal varices, it is essential to confirm the existence of any PPVA before treatment.
  
  
  METHODS
  The study group comprised 101 patients in whom hemodynamics were evaluated on three-dimensional computed tomography (3D-CT) before either elective or prophylactic treatment of esophageal varices at Kitasato University East Hospital from October 2007 through August 2013. The presence or absence of PPVA, laboratory test results and 3D-CT findings were retrospectively examined in these patients.
  
  
  RESULTS
  Nine patients had PPVA, and 92 patients did not. The underlying diseases in the PPVA group were: hepatitis C liver cirrhosis in three; non-B, non-C liver cirrhosis in three; non-alcoholic steatohepatitis in one; primary biliary cirrhosis in one; and autoimmune hepatitis in one. The distribution of underlying diseases did not differ between the PPVA group and the non-PPVA group. When the study variables were statistically compared between the groups, the incidence of large, coil-shaped esophageal varices (grade F3) differed significantly between the groups (P = 0.001). Multivariate analyses of factors related to PPVA revealed that only the grade F3 type of esophageal varices differed significantly between the groups (P = 0.005; hazard ratio, 5.21; 95% confidence interval, 3.1-16.4).
  
  
  CONCLUSIONS
  In patients with grade F3 esophageal varices, the treatment method should be selected on the basis of an accurate hemodynamic analysis using 3D-CT before therapy.
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Hidaka
authors.affiliation: Department of Diagnostic Radiology, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Matsunaga
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Kousuke
authors.initials: K
authors.lastname: Kubota
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Yamane
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Minamino
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Juichi
authors.initials: J
authors.lastname: Takada
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okuwaki
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Takahide
authors.initials: T
authors.lastname: Nakazawa
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
authors.affiliation: Departments of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Wasaburo
authors.initials: W
authors.lastname: Koizumi
keywords: endoscopic injection sclerotherapy; endoscopic variceal ligation; hemodynamics; three-dimensional computed tomography