HEMODYNAMICS OF ESOPHAGEAL VARICES ON THREE-DIMENSIONAL ENDOSCOPIC ULTRASONOGRAPHY AND INDICATION OF ENDOSCOPIC VARICEAL LIGATION

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概要

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• <B>Background:</B>Esophageal varices are treated by endoscopic variceal ligation or sclerotherapy, but the indications for each procedure are not standardized. This study was designed to determine the indication of endoscopic variceal ligation based on vascular pattern classified by three-dimensional endoscopic ultrasonography (3D-EUS).<BR> <B>Methods:</B> The pattern of variceal blood flow detected on 3D images was classified into type 1 (cardial-inflow without paraesophageal veins), type 2 (cardial-inflow with paraesophageal veins), type 3 (an azygos-perforating pattern), and type 4 (complex pattern). 3D-EUS was performed in 89 patients with esophageal varices. Subsequently, ligation was performed in 44 patients while sclerotherapy with 5% ethanolamine oleate was applied in 45 patients in a prospective randomized trial. Clinical outcome was assessed.<BR> <B>Results:</B> Based on the 3D-EUS data, 41 patients (46.1%), were classified as type 1, 12 (13. 5%) as type 2, 7 (7.9%) as type 3, and 29 patients (32.6%) as type 4. The cumulative recurrence-free probability at 24 months after treatment was 28.9% for ligation vs. 71.1% for sclerotherapy (P<0.05) in type 1, while the respective probabilities were 72.9% vs. 50.0% (NS) for type 2 varices, 100% vs. 100% (NS) for type 3 varices, and 61.9% vs. 64.8% (NS) for type 4 varices.<BR> <B>Conclusions:</B> Classification of the vascular pattern of esophageal varices by 3D-EUS enabled us to clarify the criteria for selection of endoscopic procedure. Ligation is indicated for patients who have collaterals such as paraesophageal veins running parallel to the varices, as the blood flow can be diverted to these blood vessels and controlled by localized ligation.

• 社団法人 日本消化器内視鏡学会の論文

社団法人 日本消化器内視鏡学会 | 論文

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