| Theme |
Diagnosis and Treatment of Portal Hypertention |
| Title |
Usefulness of Endoscopic Ultrasonography for Diagnosis and Treatment of Esophageal Varices |
| Author |
Shinichi Nakamura |
Institute of Gastroenterology, Tokyo Women's Medical University |
| Author |
Yoko Murata |
Murata Clinic |
| Author |
Ryujiro Imai |
Institute of Gastroenterology, Tokyo Women's Medical University |
| Author |
Maiko Kishino |
Institute of Gastroenterology, Tokyo Women's Medical University |
| Author |
Hiroyuki Konishi |
Institute of Gastroenterology, Tokyo Women's Medical University |
| Author |
Keiko Shiratori |
Institute of Gastroenterology, Tokyo Women's Medical University |
| [ Summary ] |
At the present time, both endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are widely performed as endoscopic treatments for esophageal varices. It is necessary for safe and rational treatment to understand variceal hemodynamics before treatment. It is impossible to clearly visualize the relationship between regional vascular systems inside and outside the esophageal wall from the cardia of the stomach to the distal esophagus with conventional endoscopy. In this respect, endoscopic ultrasonography (EUS) is a useful method for performing evaluation, both before and after treatment since, it is capable of clearly depicting the relationship between esophageal varices and vascular systems outside the esophageal wall and is noninvasive. We observed vascular patterns of esophageal varices using 3 D-EUS. The results obtained with EVL and EIS were similar in patients with paraesophageal veins arising from the posterior branch of the left gastric vein (LGV) with perforating veins as the feeding vessels. However in patients without paraesophageal veins whose feeding vessels were mainly the anterior branches of the LGV, EVL was associated with a higher recurrence than EIS and thus the feeding vessels should be obliterated by intravariceal EIS. The vascular pattern of esophageal varices classified by 3 D-EUS enabled us to clarify the criteria for making a choice of endoscopic procedures. |