Analysis of portal hemodynamics in long-term recurrence-free patients after endoscopic variceal ligation (EVL): Evaluation with endoscopic ultrasonography

Keisuke Oikawa, Shuichi Ohara, Kouichi Sugiyama, Hitoshi Sekine, Tomoyuki Koike, Yasushi Kitagawa, Tooru Shimosegawa

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background and Aims: Endoscopic variceal ligation (EVL) is superior to endoscopic injection sclerotherapy (EIS) with respect to the simplicity and safety. However, indication of EVL should be carefully determined because long-term effectiveness of EVL remains controversial, though a small number of patients are experienced to be free from recurrence after EVL. The relationship between the findings on endoscopic ultrasonography (EUS) and recurrence rate was studied to elucidate the portal hemodynamics in long-term recurrence-free patients after EVL. Materials and Methods: The subjects consisted of 22 patients who were followed-up for more than 2 years after EVL. EUS observation of hemodynamics was performed at the paraesophageal vein (PEV), extragastric vein (EGV) and esophageal perforating vein (EPV). PEV consititutes collateral blood flow in the esophageal outer wall. EGV is located in the lesser curvature of the cardia as a direct inflow route for the blood supply to the esophagogastric varices. EPV penetrates the esophageal wall to connect outer and inner blood flows. Analyses were performed on the relationships (1) between the size of PEV and EGV before EVL and the recurrence rate, (2) between the visibility of EPV and the recurrence rate, and (3) between the visibility of EPV and the change in the size of PEV after EVL. Results: (1) The recurrence rate was significantly higher (p<0.01) in the patients with more dilated EGV before EVL on EUS. In contrast, no significant relationship was noted between the dilatation of PEV and the recurrence rate. (2) The 2 year recurrence rate was 93.8% in the patients with visible EPV, which was significantly higher (p<0.05) than that in the patients without visible EPV (50%). Excluding patients with severe dilatation of EGV, varices recurred in 11 of 12 patients (91.7%) with visible EPV. In contrast, no recurrence was noted for more than 2 years after EVL in 3 patients without visible EPV. Irrespective of the visibility of EPV, varices recurred within 1 year after EVL in all patients with severe dilatation of EGV. (3) Compared with the patients without visible EPV, the increase in the total PEV area was significantly (p<0.05) higher in the patients with visible EPV. It was suggested that PEV increased in size after EVL in the patients without visible EPV. Conclusions: Based on the present results, it was considered that mild dilatation of EGV and invisible EPV may be favorable hemodynamic factors for good prognosis after EVL. In the patients who show conditions, a long recurrence free period is expected because such preferable hemodynamic changes, that is a development of drainage of blood supplying the esophageal wall to PEV, would occur after EVL. EVL should be the first-choice treatment in such cases. Preoperative EUS is an important method for determining the indication of EVL.

Original languageEnglish
Pages (from-to)3-11
Number of pages9
JournalGASTROENTEROLOGICAL ENDOSCOPY
Volume45
Issue number1
Publication statusPublished - 2003 Jan 1

Keywords

  • Endoscopic ultrasonography
  • Endoscopic variceal ligation (EVL)
  • Esophageal varices

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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