title: Subtypes and clinical significance of common bile duct varices in portal vein thrombosis: diagnosis and follow-up by Doppler US and EUS.
abstract: OBJECTIVE
  To investigate (1) diagnostic performance of transabdominal color doppler ultrasound (US) and endoscopic ultrasound (EUS) for detection and sub-classification of common bile duct varices (CBDV) in patients with portal vein thrombosis (PVT), and (2) clinical significance and natural history of CBDV subtypes.
  
  
  METHODS
  During a 4-year period, 56 patients with PVT underwent US and EUS for the presence and subtypes of CBDV. Natural history was analyzed for patients who attended control visits.
  
  
  RESULTS
  CBDV were diagnosed in 57 and 59 % of patients with US and EUS, respectively. In 19 % of patients, EUS revealed different CBDV subtypes than previously seen by US. The most common were paracholedochal (PCV), while the least common were epicholedochal (ECV) and Submucosal varices (SMV). Nine patients had obstructive jaundice and underwent ERCP which was complicated by hemobilia in two patients with SMV. Among eight patients who underwent control EUS (median follow-up 60 months), the form of CBDV remained unchanged. Two patients bled from esophageal varices, both with ECV.
  
  
  CONCLUSIONS
  While abdominal US and EUS are equally sensitive for detection of CBDV, EUS allows more precise determination of CBDV subtype. Patients with SMV might be at increased risk of bleeding upon ERCP.
authors.affiliation: Division of Liver Diseases, Department of Gastroenterology, University Hospital Dubrava, University of Zagreb School of Medicine, Av. Gojka Suska 6, 10 000, Zagreb, Croatia. ivica.grgurevic@zg.htnet.hr.|Faculty of Pharmacy and Biochemistry, University of Zagreb School of Medicine, Zagreb, Croatia. ivica.grgurevic@zg.htnet.hr.
authors.forename: Ivica
authors.initials: I
authors.lastname: Grgurevic
authors.affiliation: Division of Liver Diseases, Department of Gastroenterology, University Hospital Dubrava, University of Zagreb School of Medicine, Av. Gojka Suska 6, 10 000, Zagreb, Croatia.|Faculty of Pharmacy and Biochemistry, University of Zagreb School of Medicine, Zagreb, Croatia.
authors.forename: Milan
authors.initials: M
authors.lastname: Kujundzic
authors.affiliation: Division of Liver Diseases, Department of Gastroenterology, University Hospital Dubrava, University of Zagreb School of Medicine, Av. Gojka Suska 6, 10 000, Zagreb, Croatia.|University of Rijeka School of Medicine, Rijeka, Croatia.
authors.forename: Marko
authors.initials: M
authors.lastname: Banic
authors.affiliation: Department of Hematology and Division of Molecular Diagnostics and Genetics, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia.
authors.forename: Rajko
authors.initials: R
authors.lastname: Kusec
authors.affiliation: Division of Liver Diseases, Department of Gastroenterology, University Hospital Dubrava, University of Zagreb School of Medicine, Av. Gojka Suska 6, 10 000, Zagreb, Croatia.|Faculty of Pharmacy and Biochemistry, University of Zagreb School of Medicine, Zagreb, Croatia.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Bokun
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Vukelic-Markovic
authors.affiliation: Department of Medicine, Jacobi Medical Centre, Albert Einstein School of Medicine, New York, NY, USA.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Bogdanovic
authors.affiliation: Intensive Care Unit, Varazdin General Hospital, Varazdin, Croatia.
authors.forename: Anita
authors.initials: A
authors.lastname: Lukic
authors.affiliation: UCL Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Tsochatzis
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia.
authors.forename: Boris
authors.initials: B
authors.lastname: Brkljacic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003135:Common Bile Duct / Q000098:blood supply* / Q000000981:diagnostic imaging; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology*; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color; D014648:Varicose Veins / Q000150:complications / Q000000981:diagnostic imaging*; D020246:Venous Thrombosis / Q000150:complications*; D055815:Young Adult
keywords: Cholestasis; Doppler; Endosonography; Extrahepatic; Hypertension; Portal; Ultrasonography; Venous thrombosis