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1
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Dragomir I, Pojoga C, Hagiu C, Seicean R, Procopet B, Seicean A. Endoscopic ultrasound in portal hypertension: navigating venous hemodynamics and treatment efficacy. Gastroenterol Rep (Oxf) 2024; 12:goae082. [PMID: 39281269 PMCID: PMC11398876 DOI: 10.1093/gastro/goae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/23/2024] [Accepted: 06/07/2024] [Indexed: 09/18/2024] Open
Abstract
Portal hypertension-related complications increase mortality in patients, irrespective of its etiology. Classically, endoscopic ultrasound (EUS) was used to assess the portal venous system and collaterals, considering size and hemodynamic parameters, which correlate with portal hypertension (PH) and related complications. Furthermore, therapeutic EUS guides treatment interventions, such as embolization of the gastric varices through coil placement and tissue adhesive injection, yielding encouraging clinical results. Recently, the direct measurement of portal pressure, emerging as an alternative to hepatic venous pressure gradient, has shown promise, and further research in this area is anticipated. In this review, we aimed to provide a detailed description of various possibilities for diagnosing vascular anatomy and hemodynamics in PH and actual knowledge on the EUS usefulness for PH vessel-related complications. Also, future promises for this field of endo-hepatology are discussed.
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Affiliation(s)
- Irina Dragomir
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj Napoca, Romania
| | - Cristina Pojoga
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj Napoca, Romania
- UBB Med, Babeş-Bolyai University, Department of Clinical Psychology and Psychotherapy, International Institute for Advanced Study of Psychotherapy and Applied Mental Health, Cluj Napoca, Romania
| | - Claudia Hagiu
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj Napoca, Romania
| | - Radu Seicean
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
- First Surgical Clinic, County Emergency Hospital, Cluj Napoca, Romania
| | - Bogdan Procopet
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj Napoca, Romania
| | - Andrada Seicean
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania
- Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, Cluj Napoca, Romania
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2
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Shiratori Y, Yamamoto K, Okuyama S, Yoshimoto T, Ikeya T, Okada S, Fukuda K, Rateb G. Evaluation and management of esophageal varices by through-the-scope endoscopic Doppler probe method. Dig Endosc 2022; 34:1370-1379. [PMID: 35488450 DOI: 10.1111/den.14345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/27/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Objective assessments of esophageal varices (EVs) are inadequate. The recurrence of variceal bleeding after endoscopic variceal ligation (EVL) is associated with residual blood flow underlying EVL or incomplete treatment of a perforating vein by EVL. We aimed to assess our novel through-the-scope endoscopic Doppler probe method (DOP) for the evaluation and management of EVs. METHODS This study included 20 patients (54 varices) with a history of esophageal variceal rupture from June 2019 to May 2021 who underwent DOP at a tertiary hospital. Variceal velocities were compared based on the size and endoscopic variceal findings. Additionally, we performed EVL assisted by DOP (EVL + DOP) in nine patients. RESULTS Doppler imaging of EVs was observed in all 20 patients. The velocity of varices was significantly higher in EVs with a larger size, greater form, blue color, and red color sign positive. Perforating veins connecting to the EVs were identified in six out of nine patients who underwent EVL + DOP. Eight out of nine patients underwent repeat EVL. Repeat EVL was performed until the variceal velocity reached absent. No recurrence of variceal bleeding occurred during the follow-up period (mean 8.7 ± 3.2 months). No adverse events associated with DOP were observed. CONCLUSION The evaluation of EVs using DOP is feasible and accurate. EV velocities are related to the variceal size, form, blue color, and red color sign. EVL + DOP may be a more reliable treatment for EVs. Further large-scale, long-term comparative studies are warranted.
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Affiliation(s)
- Yasutoshi Shiratori
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.,Department of Gastroenterology, Sherbrooke University Hospital, Sherbrooke, Canada
| | - Kazuki Yamamoto
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Shuhei Okuyama
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Takaaki Yoshimoto
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Syuichi Okada
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - George Rateb
- Department of Gastroenterology, Sherbrooke University Hospital, Sherbrooke, Canada
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3
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Furuichi Y, Sato K, Kato H. Through-the-scope endoscopic Doppler probe method before endoscopic variceal ligation. Dig Endosc 2022; 34:1380-1381. [PMID: 35945165 DOI: 10.1111/den.14395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/30/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Yoshihiro Furuichi
- Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University, Adachi Medical Center, Tokyo, Japan
| | - Koichiro Sato
- Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University, Adachi Medical Center, Tokyo, Japan
| | - Hiroyuki Kato
- Department of Clinical Laboratory and Endoscopy, Tokyo Women's Medical University, Adachi Medical Center, Tokyo, Japan
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4
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Shiratori Y, Yoshimoto T, Yamamoto K. Esophageal variceal treatment using a novel Doppler probe method. Endoscopy 2021; 53:E419-E420. [PMID: 33506469 DOI: 10.1055/a-1324-2591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Yasutoshi Shiratori
- Division of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Takaaki Yoshimoto
- Division of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuki Yamamoto
- Division of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
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5
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Maruyama H, Shiina S. Collaterals in portal hypertension: anatomy and clinical relevance. Quant Imaging Med Surg 2021; 11:3867-3881. [PMID: 34341755 DOI: 10.21037/qims-20-1328] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/07/2021] [Indexed: 12/14/2022]
Abstract
Portal hypertension is a key pathophysiology of chronic liver diseases typified with cirrhosis or noncirrhotic portal hypertension. The development of collateral vessels is a characteristic feature of impaired portal hemodynamics. The paraumbilical vein (PUV), left gastric vein (LGV), posterior gastric vein (PGV), short gastric vein (SGV), splenorenal shunt (SRS), and inferior mesenteric vein (IMV) are major collaterals, and there are some rare collaterals. The degree and hemodynamics of collateral may affect the portal venous circulation and may compensate for the balance between inflow and outflow volume of the liver. Additionally, the development of collateral shows a relation with the liver function reserve and clinical manifestations such as esophageal varices (EV), gastric varices, rectal varices and the other ectopic varices, hepatic encephalopathy, and prognosis. Furthermore, there may be an interrelationship in the development between different collaterals, showing additional influences on the clinical presentations. Thus, the assessment of collaterals may enhance the understanding of the underlying pathophysiology of the condition of patients with portal hypertension. This review article concluded that each collateral has a specific function depending on the anatomy and hemodynamics and is linked with the relative clinical presentation in patients with portal hypertension. Imaging modalities may be essential for the detection, grading and evaluation of the role of collaterals and may help to understand the pathophysiology of the patient condition. Further investigation in a large-scale study would elucidate the basic and clinical significance of collaterals in patients with portal hypertension and may provide information on how to manage them to improve the prognosis as well as quality of life.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Juntendo University, Tokyo, Japan
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6
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Yokoyama K, Miyayama T, Uchida Y, Fukuda H, Yamauchi R, Tsuchiya N, Umeda K, Takata K, Tanaka T, Inomata S, Morihara D, Takeyama Y, Shakado S, Sakisaka S, Hirai F. Novel Endoscopic Therapy for Gastric Varices Using Direct Forward-Viewing Endoscopic Ultrasonography. Case Rep Gastroenterol 2021; 15:28-34. [PMID: 33613160 PMCID: PMC7879242 DOI: 10.1159/000510132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022] Open
Abstract
Gastric varices (GV) carry a high risk of massive hemorrhage because of potential rupture. To reduce the risk associated with GV, patients need to undergo hemostatic and preventive treatment. The objective of this retrospective study was to evaluate the usefulness of a new method, direct forward-viewing endoscopic ultrasonography (DFV-EUS) for the treatment of GV. We performed endoscopic injection sclerotherapy with histoacryl (EIS-HA) using DFV-EUS for GV in four patients. The paracentesis success rate was 75% (3/4). DFV-EUS has a significant advantage for the treatment of GV in that it can show physicians endoscopic and ultrasound views in real time during the delivery of the sclerosant into the GV. However, the proper use of the ultrasound view must be elucidated through further research for safer and more effective therapy. In the presence of distance between the mucosal surface and vascular lumen or when the blood flow site requires puncture as an additional treatment, DFV-EUS might be a good candidate for the treatment of GV. Altogether, EIS-HA with DFV-EUS might be a new therapeutic option for patients with GV.
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Affiliation(s)
- Keiji Yokoyama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takashi Miyayama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yotaro Uchida
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hiromi Fukuda
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Ryo Yamauchi
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Naoaki Tsuchiya
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kaoru Umeda
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kazuhide Takata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takashi Tanaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shinjiro Inomata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Daisuke Morihara
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yasuaki Takeyama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Satoshi Shakado
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shotaro Sakisaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Cannella R, Giambelluca D, Pellegrinelli A, Cabassa P. Color Doppler Ultrasound in Portal Hypertension: A Closer Look at Left Gastric Vein Hemodynamics. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:7-14. [PMID: 32657462 DOI: 10.1002/jum.15386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 06/11/2023]
Abstract
Portal hypertension is one of the most important causes of morbidity and mortality in cirrhotic patients. A color Doppler evaluation of the left gastric vein (LGV) has proven utility in the prediction of esophageal varices and variceal bleeding in patients with portal hypertension. The purpose of this review is to discuss the ultrasound evaluation, imaging findings, and clinical application of Doppler ultrasound in the assessment of the LGV. Knowledge of the color Doppler technique and imaging findings of the LGV may help clinicians improve the monitoring of portal hypertension and predict patients with a high risk of esophageal varices.
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Affiliation(s)
- Roberto Cannella
- Department of Biomedicine, Neuroscience, and Advanced Diagnostics, Section of Radiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Dario Giambelluca
- Department of Radiology, Azienda Socio Sanitaria Territoriale della Franciacorta, Presidio Ospedaliero Mellino Mellini, Chiari, Italy
| | - Alice Pellegrinelli
- Department of Radiology, Azienda Socio Sanitaria Territoriale della Franciacorta, Presidio Ospedaliero Mellino Mellini, Chiari, Italy
| | - Paolo Cabassa
- Department of Radiology, Azienda Socio Sanitaria Territoriale della Franciacorta, Presidio Ospedaliero Mellino Mellini, Chiari, Italy
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8
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Nagashima K, Irisawa A, Tominaga K, Kashima K, Kunogi Y, Minaguchi T, Izawa N, Yamamiya A, Yamabe A, Hoshi K, Goda K, Iijima M. The Role of Endoscopic Ultrasound for Esophageal Varices. Diagnostics (Basel) 2020; 10:1007. [PMID: 33255736 PMCID: PMC7760989 DOI: 10.3390/diagnostics10121007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022] Open
Abstract
Esophageal varices are caused by the development of collateral circulation in the esophagus as a result of portal hypertension. It is important to administer appropriate preventive treatment because bleeding varices can be fatal. Esophageal varices have complex and diverse hemodynamics, and there are various variations for each case. Endoscopic ultrasound (EUS) can estimate the hemodynamics of each case. Therefore, observation by EUS in esophageal varices provides useful information, such as safe and effective treatment selection, prediction of recurrence, and appropriate follow-up after treatment. Although treatment for the esophagogastric varices can be performed without EUS imaging, understanding the local hemodynamics of the varices using EUS prior to treatment will lead to more safe and effective treatment. EUS observation is an indispensable tool for thorough variceal care.
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Affiliation(s)
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (K.N.); (K.T.); (K.K.); (Y.K.); (T.M.); (N.I.); (A.Y.); (A.Y.); (K.H.); (K.G.); (M.I.)
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9
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Campos S, Poley JW, van Driel L, Bruno MJ. The role of EUS in diagnosis and treatment of liver disorders. Endosc Int Open 2019; 7:E1262-E1275. [PMID: 31579708 PMCID: PMC6773586 DOI: 10.1055/a-0958-2183] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/07/2019] [Indexed: 02/06/2023] Open
Abstract
Background and aim Transabdominal ultrasound (US), computed tomographic scanning (CT) and magnetic resonance imaging (MRI) are established diagnostic tools for liver diseases. Percutaneous transhepatic cholangiography is used to perform hepatic interventional procedures including biopsy, biliary drainage procedures, and radiofrequency ablation. Despite their widespread use, these techniques have limitations. Endoscopic ultrasound (EUS), a tool that has proven useful for evaluating the mediastinum, esophagus, stomach, pancreas, and biliary tract, has an expanding role in the field of hepatology complementing the traditional investigational modalities. This review aimed to assess the current scientific evidence regarding diagnostic and therapeutic applications of EUS for hepatic diseases.
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Affiliation(s)
- Sara Campos
- Department of Gastroenterology, Hospital Garcia da Orta, Portugal
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
| | - Lydi van Driel
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, The Netherlands
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10
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Magalhães J, Monteiro S, Xavier S, Leite S, de Castro FD, Cotter J. Endoscopic ultrasonography - emerging applications in hepatology. World J Gastrointest Endosc 2017; 9:378-388. [PMID: 28874958 PMCID: PMC5565503 DOI: 10.4253/wjge.v9.i8.378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/14/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023] Open
Abstract
The inspection of the liver is a valuable part of the upper endoscopic ultrasonography (EUS) studies, regardless of the primary indication for the examination. The detailed images of the liver segments provided by EUS allows the use of this technique in the study of parenchymal liver disease and even in the diagnosis and classification of focal liver lesions. EUS has also emerged as an important tool in understanding the complex collateral circulation in patients with portal hypertension and their clinical and prognostic value. Recently, EUS-guided portal vein catheterization has been performed for direct portal pressure measurement as an alternative method to evaluate portal hemodynamics. In this review, the authors summarize the available evidence regarding the application of EUS to patients with liver diseases and how we can apply it in our current clinical practice.
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11
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A Erdogan M, R Benli A, B Acmali S, Koroglu M, Atayan Y, Danalioglu A, Kayhan B. Predictive Value of Mean Platelet Volume in Variceal Bleeding due to Cirrhotic Portal Hypertension. Euroasian J Hepatogastroenterol 2017; 7:6-10. [PMID: 29201764 PMCID: PMC5663766 DOI: 10.5005/jp-journals-10018-1203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/25/2016] [Indexed: 12/22/2022] Open
Abstract
Aim: To investigate whether mean platelet volume (MPV) is a predictor of variceal bleeding in patients with cirrhotic portal hypertension. Materials and methods: This prospective cohort was performed in the internal medicine department of our tertiary care center. Cirrhotic patients were allocated into two groups: Group I consisted of 31 cases without a history of variceal bleeding, whereas group II was made up of 31 patients with a history of variceal bleeding. Data derived from medical history, physical examination, ultrasonography, gastrointestinal system endoscopy, complete blood count, hepatic, and renal function tests were recorded and compared between two groups. On physical examination, encephalopathy and ascites were evaluated and graded with respect to Child-Pugh-Turcotte classification. Results: There was no significant difference between the two groups in terms of age, duration of the disease, and gender of the patient. The only remarkable difference was that hemoglobin (p = 0.02) and hematocrit (p = 0.02) values were lower in group II. Neither the etiology of bleeding was different between groups nor did MPV seem to have a noteworthy impact on bleeding. Interestingly, risk of variceal bleeding increased in parallel to the higher grade of varices. Conclusion: Our results imply that there is a correlation between the grade of varices and esophageal vari-ceal bleeding in cirrhotic patients. However, association between MPV and variceal bleeding could not be demonstrated. Utilization of noninvasive tests as predictors in these patients necessitates further controlled trials on larger series. How to cite this article: Erdogan MA, Benli AR, Acmali SB, Koroglu M, Atayan Y, Danalioglu A, Kayhan B. Predictive Value of Mean Platelet Volume in Variceal Bleeding due to Cirrhotic Portal Hypertension. Euroasian J Hepato-Gastroenterol 2017;7(1):6-10.
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Affiliation(s)
- Mehmet A Erdogan
- Department of Gastroenterology, Karabük Education and Research Hospital, Karabük University, Karabük, Turkey
| | - Ali R Benli
- Department of Family Medicine, Karabük University, Karabük, Turkey
| | - Serap B Acmali
- Department of Family Medicine, Dudullu Aile Sağliği Merkezleri, Istanbul Turkey
| | - Mustafa Koroglu
- Department of Hematology, Karabük University, Karabük, Turkey
| | - Yahya Atayan
- Department of Gastroenterology, Gümüshane State Hospital Gümüşhane, Turkey
| | - Ahmet Danalioglu
- Department of Internal Medicine, Bezmiâlem Vakif University, Istanbul, Turkey
| | - Burcak Kayhan
- Department of Internal Medicine Karabük University, Karabük, Turkey
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12
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Weilert F, Binmoeller KF. Endoscopic management of gastric varices. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2017. [DOI: 10.1016/j.tgie.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Wang AJ, Li BM, Zheng XL, Shu X, Zhu X. Utility of endoscopic ultrasound in the diagnosis and management of esophagogastric varices. Endosc Ultrasound 2016; 5:218-24. [PMID: 27503152 PMCID: PMC4989401 DOI: 10.4103/2303-9027.187840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Endoscopic ultrasound (EUS) has significantly improved our understanding of the complex vascular structural changes in patients with portal hypertension. At present, EUS is a useful diagnostic tool for the evaluation of esophagogastric varices (EGVs) and guidance of endoscopic therapy. Several studies have employed this new technique for the diagnosis and management of esophageal and gastric varices, respectively. In the present review, we have summarized the current status of EUS for the diagnosis and management of EGVs and clarified the clinical feasibility of this procedure. New indications for EUS can be developed in the future after adequate validation.
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Affiliation(s)
- An-Jiang Wang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Bi-Min Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Xue-Lian Zheng
- Department of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Xu Shu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Xuan Zhu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
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14
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Abstract
Expert knowledge of endoscopic management of gastric varices is essential, as these occur in 20% of patients with portal hypertension. Bleeding is relatively uncommon, but carries significant mortality when this occurs. Inability to directly target intravascular injections and the potential complication related to glue embolization has resulted in the development of novel techniques. Direct visualization of the varix lumen using endoscopic ultrasound (EUS) allows targeted therapy of feeder vessels with real-time imaging. EUS-guided combination therapy with endovascular coiling and cyanoacrylate injections promise to provide reduced complication rates, increased obliteration of varices, and reduced long-term rebleeding rates.
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Affiliation(s)
- Frank Weilert
- Department of Gastroenterology, Waikato Hospital, Pembroke Street, Hamilton 2001, New Zealand
| | - Kenneth F Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, 2351 Clay Street, 6th Floor, San Francisco, CA 94115, USA.
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15
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Binmoeller KF, Sendino O, Kane SD. Endoscopic ultrasound-guided intravascular therapy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 22:44-50. [PMID: 25366271 DOI: 10.1002/jhbp.183] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The gastrointestinal tract provides a unique "window" to access vascular structures in the mediastinum and abdomen. The advent of interventional endoscopic ultrasound (EUS) has enabled access to these structures with a standard fine-needle aspiration (FNA) needle. Sclerosants, cyanoacrylate, and coils can be delivered through the lumen of the FNA needle. EUS-guided treatment of gastric varices has theoretical advantages over conventional endoscopy-guided treatment. Controlled studies are needed to determine the role of EUS-guided treatment for primary and secondary prevention of variceal bleeding. There is a growing list of novel indications for EUS-guided vascular therapy that include portal vein angiography and pressure measurements, intrahepatic portosystemic shunt placement, and micro coil embolization of vascular structures. Additionally, access and therapy of the heart and surrounding structures appears feasible.
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Affiliation(s)
- Kenneth F Binmoeller
- Paul May and Frank Stein Interventional Endoscopy Services, California Pacific Medical Center, Suite 600, Stanford Building, 2351 Clay Street, San Francisco, CA, 94115, USA.
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16
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How do we select an endoscopic treatment for esophageal varices on the basis of hemodynamic analysis using color Doppler endoscopic ultrasonography. Surg Laparosc Endosc Percutan Tech 2013; 22:410-4. [PMID: 23047383 DOI: 10.1097/sle.0b013e3182610920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
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Shim JJ. Usefulness of endoscopic ultrasound in esophagogastric varices. Clin Endosc 2012; 45:324-7. [PMID: 22977828 PMCID: PMC3429762 DOI: 10.5946/ce.2012.45.3.324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 07/23/2012] [Accepted: 07/24/2012] [Indexed: 12/21/2022] Open
Abstract
Endoscopic ultrasound (EUS) is a useful diagnostic tool for evaluation of esophagogastric varices and guidance of endoscopic therapy. EUS can visualize not only collateral veins around the esophagus but also perforating veins that connect esophageal varices with collateral veins. They are associated with high risk of bleeding and early recurrence after initial variceal eradication. Isolated gastric varices can be easily diagnosed using EUS that mimic thickened gastric folds or subepithelial tumors. EUS-guided endoscopic therapy is a challenging field of variceal bleeding. It has a potential role for assistance of interventions and evaluation of treatment outcome.
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Affiliation(s)
- Jae-Jun Shim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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18
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Abstract
The gastrointestinal tract provides a unique window to access vascular structures in the mediastinum and abdomen. The advent of interventional endoscopic ultrasound (EUS) has enabled access to these structures with standard fine-needle aspiration. EUS-guided treatment of varices has been largely reserved as rescue therapy for refractory bleeding but has theoretic advantages over conventional endoscopy-guided treatment. Data are limited and multicenter, prospective controlled trials are needed to show clinical effectiveness and safety in humans. The development of new tools designed for EUS-guided vascular therapy is needed.
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Affiliation(s)
- Frank Weilert
- Peter Stokes Endoscopy Unit, Waikato District Health Board, Waikato Hospital, Pembroke Street, Hamilton 3200, New Zealand
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19
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Ginès A, Fernández-Esparrach G. Endoscopic ultrasonography for the evaluation of portal hypertension. Clin Liver Dis 2010; 14:221-9. [PMID: 20682231 DOI: 10.1016/j.cld.2010.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Since the 1980s, endoscopic ultrasonography (EUS) has been useful in the evaluation of portal hypertension, either for the diagnostic aspects or for the evaluation of therapy and risk of bleeding. More recently, it has been described as a method for guiding interventions such as variceal injection, portal vein catheterization, or even for creating an intrahepatic portosystemic shunt in the animal laboratory. The new generation of radial electronic echoendoscopes is equipped with color Doppler capability, allowing for measurement of any hemodynamic parameter of the portal circulation. This article summarizes the current knowledge on the role of EUS for the evaluation of portal hypertension.
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Affiliation(s)
- Angels Ginès
- Institut de Malalties Digestives i Metabòliques, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Spain.
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20
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Clinical experience with newer electronic radial-type endoscopic color Doppler ultrasonography in the diagnosis of esophageal varices. J Med Ultrason (2001) 2010; 37:117-21. [PMID: 27278010 DOI: 10.1007/s10396-010-0262-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 02/18/2010] [Indexed: 12/31/2022]
Abstract
PURPOSE Endoscopic color Doppler ultrasonography (ECDUS) is a method for obtaining color images of flow in blood vessels. In this study, we report the utility of a newer electronic radial ECDUS for evaluating cases with esophageal varices. METHODS Nineteen patients with esophageal varices were selected. The ECDUS was performed using a Pentax EG-3670URK (forward-view) with a distal tip diameter of 12 mm. A Hitachi EUB 7500, which provides a 360° view, was used for display. RESULTS The newer electronic radial ECDUS more clearly delineates images of vessels in patients with esophageal varices. We found two chief advantages over the old probe, i.e., it is easier to manipulate in the distal esophagus than the old probe and it produces 360° images instead of 60° or 270° images. CONCLUSION Forward-view optics and an extended 360° viewing angle enabled clear color flow images to be obtained from all cases of esophageal varices examined.
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21
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Microwave coagulation versus sclerotherapy after band ligation to prevent recurrence of high risk of bleeding esophageal varices in Child-Pugh's A and B patients. J Gastroenterol 2010; 45:204-10. [PMID: 19802519 DOI: 10.1007/s00535-009-0134-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 08/25/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND The combination of endoscopic band ligation (EBL) with either endoscopic injection sclerotherapy (EIS) or thermal therapy has been shown to reduce recurrence of esophageal varices compared to EBL alone. The aim of this prospective trial was twofold: 1) to evaluate the safety and efficacy of EBL used in association with microwave coagulation (MC), a thermal endoscopic therapy method, for treating esophageal varices and preventing recurrence; and 2) to compare these results to the joint application of EBL and EIS. METHODS Seventy cirrhotic patients with bleeding esophageal varices were treated with EBL until only thin vessels remained. Thirty-six randomly selected patients received EIS (group A) and 34 received MC (group B) until complete eradication had been achieved. Endoscopic follow-up was performed to detect recurrence. The effectiveness of the treatment was measured using variceal recurrence, rebleeding, intervention complications, and recurrence factors. RESULTS During follow-up evaluations averaging 34.9 +/- 11.4 months, no significant differences were found between groups A and B in variceal recurrence (27.7 vs. 17.6%, P = 0.31) or rebleeding (8.3 vs. 0%, P = 0.23). Complications were rare, with no difference detected between groups. The presence of gastric varices influenced recurrence with an odds ratio of 3.9 (95% CI 1.14-13.1, P = 0.029). CONCLUSIONS Application of MC to esophageal varices after band ligation is safe. The post-MC recurrence rate may be comparable to that observed following the combined treatment of EBL and EIS. The presence of gastric varices increases the risk of esophageal variceal recurrence.
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22
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Abstract
Endoscopic ultrasonography is currently a sensitive diagnostic and therapeutic tool with established indications, but its role in the management of portal hypertension is not well defined. This article briefly reviews indications, technologic improvements, diagnostic and interventional applications of endoscopic ultrasonography in portal hypertension.
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Elsamman MK, Fujiwara Y, Kameda N, Okazaki H, Tanigawa T, Shiba M, Tominaga K, Watanabe T, Oshitani N, Arafa UA, El-Sayed AA, Nakamura K, Arakawa T. Predictive factors of worsening of esophageal varices after balloon-occluded retrograde transvenous obliteration in patients with gastric varices. Am J Gastroenterol 2009; 104:2214-21. [PMID: 19319121 DOI: 10.1038/ajg.2008.140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Although balloon-occluded retrograde transvenous obliteration (B-RTO) is useful for management of gastric varices, worsening of esophageal varices (EV) is the most important complication of B-RTO. The predictive factors of worsening of EV have not been evaluated in detail. This study was designed to evaluate the role of endoscopic color Doppler ultrasonography (ECDUS) in the detection of possible risk factors for worsening of EV after B-RTO. METHODS A total of 39 cirrhotic patients with high-risk gastric varices successfully treated by B-RTO were included in this study. All patients underwent ECDUS before B-RTO to measure hemodynamic parameters of gastric varices and regular endoscopic follow-up after B-RTO to detect worsening of EV. The risk factors were analyzed by Cox's proportional hazards regression. RESULTS Worsening of EV was found in 24 (61.5%) patients. The presence of esophageal varices before B-RTO and a lower degree of liver dysfunction (Child-Pugh class B) were statistically independent risk factors for worsening of EV after B-RTO (hazard ratio, HR, 5.81, 95% confidence interval, CI, 1.71-19.77 and HR 2.92, 95% CI: 1.21-7, respectively). High resistance index (> or =0.24), measured by ECDUS, is also an independent risk factor for worsening of EV after B-RTO (HR 4.06, 95% CI: 1.14-14.38) and increase in resistance index is associated with worsening of EV (P for trend=0.028). CONCLUSIONS The presence of EV, higher Child-Pugh class, and higher resistance index assessed by ECDUS before B-RTO were significant risk factors for worsening of EV after B-RTO.
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Affiliation(s)
- Mahmoud K Elsamman
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
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Romero-Castro R, Pellicer-Bautista FJ, Jimenez-Saenz M, Marcos-Sanchez F, Caunedo-Alvarez A, Ortiz-Moyano C, Gomez-Parra M, Herrerias-Gutierrez JM. EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices: results in 5 cases. Gastrointest Endosc 2007; 66:402-7. [PMID: 17643723 DOI: 10.1016/j.gie.2007.03.008] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 03/04/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Bleeding from gastric varices can be challenging because of its high mortality and recurrent bleeding rates. Endoscopic therapy with tissue adhesives can control acute hemorrhage, but recurrent bleeding could appear if obliteration is not achieved, and endoscopic vision could be troublesome in the case of massive hemorrhage. The glue injected could be responsible for embolic phenomena and local complications. EUS has proved useful in minimizing the risk of recurrent bleeding from gastric varices, accurately showing if they are obturated or not. The presence of perforating veins detected by EUS has been reported as a risk factor for recurrent bleeding from esophageal varices. OBJECTIVE To assess the efficacy of EUS-guided cyanoacrylate injection in gastric varices at the entrance of the perforating veins to obtain variceal obturation. DESIGN Open-basis case series study. SETTING Tertiary care, academic medical center, Seville, Spain. PATIENTS Five consecutive patients with gastric varices were enrolled from May 2005 through May 2006. INTERVENTIONS We injected cyanoacrylate-lipiodol in gastric varices with 22-gauge needles by EUS guidance. MAIN OUTCOME MEASUREMENTS To analyze the obliteration of gastric varices, the recurrent bleeding rate, and safety of EUS-guided cyanoacrylate-lipiodol injection. RESULTS EUS-guided injection of the perforating veins by using cyanoacrylate-lipiodol was successful in eradicating gastric varices in the 5 patients treated, without recurrent bleeding or other complications during the study follow-up. LIMITATION This is a single-center nonrandomized study. CONCLUSIONS EUS-guided injection of cyanoacrylate at the level of the perforating veins in the treatment of gastric varices seems to be a safe, efficient, and accurate approach. Further controlled studies are warranted.
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Affiliation(s)
- Rafael Romero-Castro
- Service of Gastroenterology, Service of Vascular Invasive Radiology, Virgen Macarena Hospital, Seville, Spain
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Kuramochi A, Imazu H, Kakutani H, Uchiyama Y, Hino S, Urashima M. Color Doppler endoscopic ultrasonography in identifying groups at a high-risk of recurrence of esophageal varices after endoscopic treatment. J Gastroenterol 2007; 42:219-24. [PMID: 17380280 DOI: 10.1007/s00535-006-1992-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 12/04/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Our preliminary study indicated that either a high hepatofugal flow velocity in the left gastric vein (LGV) or an anterior branch dominant pattern seen under color Doppler EUS (CD-EUS) were possible contributing risk factors for variceal recurrence after endoscopic treatment. However, the sample size was too small, and in this study we aimed to validate the results of the preliminary study. METHODS Sixty-eight patients treated for moderate or large esophageal varices between 2001 and 2004 at a single university hospital were enrolled in this study. CD-EUS was followed by endoscopic variceal ligation and sclerotherapy. RESULTS Patients were classified into either a high-risk group, which exhibited anterior branch dominance and flow velocity of 12 cm/s or more, or a low-risk group, which included all other patients. Half of the patients in the high-risk group exhibited a recurrence within half a year, whereas it took almost 2 years for half of the patients in the other group to exhibit a recurrence (P=0.0044). Using the Cox proportional hazard model with multivariate analysis, only the features of the high-risk group were significant in triggering recurrence of varices (hazard ratio [HR], 3.00; 95% confidence interval [CI], 1.35-6.65; P<0.001). CONCLUSIONS These results suggest that patients showing anterior branch dominance and rapid hepatofugal flow velocity in the LGV on CD-EUS examination may have a high risk of an early recurrence of esophageal varices.
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Affiliation(s)
- Akira Kuramochi
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Sgouros SN, Bergele C, Avgerinos A. Endoscopic ultrasonography in the diagnosis and management of portal hypertension. Where are we next? Dig Liver Dis 2006; 38:289-95. [PMID: 16414317 DOI: 10.1016/j.dld.2005.11.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 11/20/2005] [Accepted: 11/25/2005] [Indexed: 12/11/2022]
Abstract
Endoscopic ultrasonography has recently emerged as an accurate, non-invasive and reproducible alternative means of providing data for patients with portal hypertension. It is well established that endoscopic ultrasonography is more sensitive than endoscopy in the diagnosis of gastric varices. Dilated venous abnormalities outside the gastrooesophageal lumen, which cannot be diagnosed by endoscopy, are readily visible with endoscopic ultrasonography or miniature probes. Endoscopic ultrasonography is also useful to predict the risk of variceal recurrence and thus the risk of rebleeding after endotherapy which cannot be reliably predicted using endoscopy alone. The introduction of echo endoscopes equipped with Doppler facilities has allowed the sonographic visualisation of the vessels and the evaluation of vascular blood flow along with possible morphologic and haemodynamic changes after endoscopic or pharmacological therapy. However, despite its theoretical advantages, relative evidence suggests that in the clinical setting of portal hypertension, endoscopic ultrasonography remains an investigational tool with limited clinical applications.
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Affiliation(s)
- S N Sgouros
- Department of Gastroenterology, Athens Naval and Veterans Hospital, Nafpaktias 5, Agia Paraskevi, 15341 Athens, Greece.
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Ito K, Matsutani S, Maruyama H, Akiike T, Nomoto H, Suzuki T, Fukuzawa T, Mizumoto H, Saisho H. Study of hemodynamic changes in portal systemic shunts and their relation to variceal relapse after endoscopic variceal ligation combined with ethanol sclerotherapy. J Gastroenterol 2006; 41:119-26. [PMID: 16568370 DOI: 10.1007/s00535-005-1730-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Accepted: 10/03/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND Among the factors influencing variceal relapse after endoscopic treatment, portal hemodynamic changes, especially in portal systemic shunts, could be the most important factor because hemodynamics are directly related to the development of esophageal varices. We aimed to clarify the influence of endoscopic treatment for esophageal varices on portal systemic shunts as well as its predictive value for variceal relapse. METHODS Fifty patients who underwent combined endoscopic variceal ligation and injection sclerotherapy were examined with sonography and portography. RESULTS Decrease of diameter, hepatopetal flow direction in the left gastric vein, or the presence of non-varices portal systemic shunt were sonographic findings related to a low incidence of variceal relapse. The presence of blood flow in and around the esophagus on venograms was highly predictive for variceal relapse. In patients with such venograms, non-varices portal systemic shunts did not develop. CONCLUSIONS Sonographic assessment of hemodynamic changes in portal systemic shunt could be useful for estimating the results of endoscopic treatment for esophageal varices.
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Affiliation(s)
- Kenji Ito
- Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
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Seno H, Konishi Y, Wada M, Fukui H, Okazaki K, Chiba T. Endoscopic ultrasonograph evaluation of vascular structures in the gastric cardia predicts esophageal variceal recurrence following endoscopic treatment. J Gastroenterol Hepatol 2006; 21:227-31. [PMID: 16460478 DOI: 10.1111/j.1440-1746.2006.04129.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM In patients with portal hypertension, early recurrence of esophageal varices often occurs following endoscopic variceal ligation therapy or ligation and injection-sclerotherapy combined treatment. To assess the recurrence risk following endoscopic treatment, this study investigated the association between recurrence-free time and severity of esophagogastric vascular structures before treatment as determined by endoscopic ultrasonography. METHODS Sixty-three patients with esophageal varices at high bleeding risk were treated by endoscopic variceal ligation therapy or ligation and injection-sclerotherapy combined treatment. Before the treatment, conventional endoscopy and endoscopic ultrasonography with a 20-MHz catheter probe were performed. Submucosal, perforating and adventitial veins in the esophagus and gastric cardia were examined. According to the endoscopic ultrasonography findings, the vascular structures were classified into two grades: mild and severe. The relationships between the endoscopic ultrasonography grades and variceal recurrence-free time were analyzed by the Kaplan-Meyer method. RESULTS Patients with severe as opposed to mild grade perforating veins in the gastric cardia had a significantly shorter recurrence-free time (P < 0.05). Those with severe paracardial veins also had a significantly shorter recurrence-free time (P < 0.01). CONCLUSION Endoscopic ultrasonography analysis for gastric cardial vascular structures before endoscopic treatment can be useful to predict the recurrence of esophageal varices.
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Affiliation(s)
- Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Annet L, Peeters F, Horsmans Y, Hermoye L, Starkel P, Van Beers BE. Esophageal Varices: Evaluation with Transesophageal MR Imaging—Initial Experience. Radiology 2006; 238:167-75. [PMID: 16304087 DOI: 10.1148/radiol.2381041728] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To prospectively use transesophageal magnetic resonance (MR) imaging to determine the morphologic and hemodynamic characteristics of esophageal varices. MATERIALS AND METHODS The study was approved by the ethics committee. All patients gave written informed consent. Forty-two patients (29 men, 13 women; mean age, 58 years +/- 11 [standard deviation]) with esophageal varices that were recently demonstrated at endoscopy were included in the study. MR imaging was performed by using a receiver probe that was placed in the esophagus. Black-blood T2-weighted MR images were obtained with cardiac triggering and navigator gating of the right hemidiaphragm. On these images, the maximal diameter, minimal diameter, and surface area of the largest esophageal varix were measured. Periesophageal and paraesophageal varices were recorded. A hemodynamic examination was performed in the last 21 patients to undergo MR imaging, which was used to obtain measurements of flow velocity and rate before and after intravenous injection of 50 mug of octreotide or a placebo. A Kruskal-Wallis test was used to assess differences in the diameter and surface area of the varices according to endoscopic grade. Hemodynamic changes observed after octreotide or placebo injection were compared by using an analysis of variance and a 95% confidence interval. RESULTS Periesophageal varices were observed in 36 patients, and paraesophageal varices were observed in 32 patients. The minimal diameter, maximal diameter, and surface area of the esophageal varices at MR imaging differed significantly according to endoscopic grade (P < .001). In the periesophageal varices, the velocity and flow changes caused by octreotide differed significantly from those caused by the placebo (P < .001). A decrease in velocity (mean velocity change, -2.766 cm.sec(-1)) and flow (mean flow change, -0.455 mL.sec(-1)) was noted after octreotide injection, but no significant change in velocity (mean velocity change, 0.252 cm.sec(-1)) or flow (mean flow change, 0.018 mL.sec(-1)) was noted after placebo injection. The surface area of the varices did not change significantly after octreotide (mean change, -0.771 mm2) or placebo (mean change, -0.015 mm2) injection. CONCLUSION Transesophageal MR imaging is a feasible method to assess the morphologic and hemodynamic characteristics of esophageal varices before and after pharmacologic treatment.
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Affiliation(s)
- Laurence Annet
- Diagnostic Radiology Unit, Center for Anatomic, Functional, and Molecular Imaging Research, Université Catholique de Louvain, St-Luc University Hospital, Avenue Hippocrate 10, B-1200 Brussels, Belgium.
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Yang VXD, Tang SJ, Gordon ML, Qi B, Gardiner G, Cirocco M, Kortan P, Haber GB, Kandel G, Vitkin IA, Wilson BC, Marcon NE. Endoscopic Doppler optical coherence tomography in the human GI tract: initial experience. Gastrointest Endosc 2005; 61:879-90. [PMID: 15933695 DOI: 10.1016/s0016-5107(05)00323-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Expanding the current endoscopic optical coherence tomography (OCT) system with Doppler capability may augment this novel high-resolution cross-sectional imaging technique with functional blood flow information. The aim of this feasibility study was to assess the clinical feasibility of an endoscopic Doppler OCT (EDOCT) system in the human GI tract. METHODS During routine endoscopy, 22 patients were imaged by using a prototype EDOCT system, which provided color-Doppler and velocity-variance images of mucosal and submucosal blood flow at one frame per second, simultaneously with high-spatial-resolution (10-25 mum) images of tissue microstructure. The images were acquired from normal GI tract and pathologic tissues. OBSERVATIONS Subsurface microstructure and microcirculation images of normal and pathologic GI tissues, including Barrett's esophagus, esophageal varices, portal hypertensive gastropathy, gastric antral vascular ectasia, gastric lymphoma, and duodenal adenocarcinoma, were obtained from 72 individual sites in vivo. Differences in vessel diameter, distribution, density, and blood-flow velocity were observed among the GI tissue pathologies imaged. CONCLUSIONS To our knowledge, this is the first study to demonstrate the feasibility of EDOCT imaging in the human GI tract during routine endoscopy procedures. EDOCT may detect the different microcirculation patterns exhibited by normal and diseased tissues, which may be useful for diagnostic imaging and treatment monitoring.
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Affiliation(s)
- Victor X D Yang
- Faculty of Medicine, Department of Medical Biophysics, University of Toronto, Canada
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Lai L, Brugge WR. Endoscopic ultrasound is a sensitive and specific test to diagnose portal venous system thrombosis (PVST). Am J Gastroenterol 2004; 99:40-4. [PMID: 14687139 DOI: 10.1046/j.1572-0241.2003.04020.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Thrombosis of the portal venous system (PVS) may complicate cirrhosis, pancreatitis, malignancies, and hypercoagulable states. Computed tomography (CT) scanning can diagnose thrombi present in the lumen of the PVS, but is probably insensitive. Endoscopic ultrasound (EUS) may be a more sensitive test for diagnosing PVS thrombosis (PVST). We sought to determine the accuracy of EUS for the diagnosis of PVST. METHODS Using a retrospective analysis of patients' studies retrieved from a database at Massachusetts General Hospital, we determined the sensitivity and specificity of EUS in 16 patients with PVST and 29 without PVST as proven by surgery and/or CT scanning. All patients underwent a linear EUS exam of the PVS and the results of the EUS report were used as the basis of the study. RESULTS The sensitivity of EUS for the finding of PVST was 81% in 13 of 16 patients and the specificity was 93% in 27 of 29 patients with an overall accuracy of 89% (40/45). In an additional group of 11 patients, EUS demonstrated the presence of a PVST that was not detected by CT scanning. CONCLUSION Linear EUS is a highly sensitive and specific test for PVST.
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Affiliation(s)
- Lawrence Lai
- GI Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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32
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de Angelis C, Isabello A, Pellicano R, Repici A, Carucci P, Rizzetto M. Apport de l’écho-endoscopie dans l’hypertension portale. ACTA ENDOSCOPICA 2003; 33:31-44. [DOI: 10.1007/bf03023671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
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Wassef W. Interventional endoscopy. Curr Opin Gastroenterol 2002; 18:669-77. [PMID: 17033346 DOI: 10.1097/00001574-200211000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Technologic milestones have been achieved in the field of interventional endoscopy. These have resulted in improved hemostasis, more accurate cancer staging, safer and less invasive methods of removing gastric neoplasms, and endoscopic palliation of malignant gastric outlet obstruction via stenting. However, just as these milestones are achieved, new challenges emerge: (1) How much sedation can one use safely? (2) What is the risk of transmitting infection and how can that be prevented? (3) Can scopes be made smaller and more comfortable? (4) Can optics be improved? (5) Can endoscopic repair of gastric perforations be safely performed? In this section, we review some of these issues. First, we will provide an update on the most recent concepts in the field of light sedation and infection control. Then, a review of the most commonly used interventional endoscopy procedures, including hemostasis, endosonography, endoscopic mucosal resection, stenting, and percutaneous gastrostomy tube placements. Finally, an overview of the ongoing research and development in the field of interventional endoscopy and how it can improve patient comfort, diagnostic accuracy, therapeutic efficacy, and training in the future.
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Affiliation(s)
- Wahid Wassef
- Division of Gastroenterology, University of Massachusetts Medical Center, Worcester, Massachusetts 01655, USA.
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Affiliation(s)
- Joseph J y Sung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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