Endoscopic ultrasonographic evaluation of hemodynamics related to variceal relapse in esophageal variceal patients.

AIM: To evaluate retrospectively the hemodynamics of esophageal varices before and after endoscopic injection sclerotherapy (EIS) using endoscopic color Doppler ultrasonography (ECDUS).

METHODS

The study included 306 patients whose esophageal varices had been treated with EIS. The underlying pathologies of portal hypertension in these 306 patients included liver cirrhosis (193), cirrhosis associated with hepatocellular carcinoma (102), primary biliary cirrhosis (6), idiopathic portal hypertension (4) and extrahepatic portal vein obstruction (1). ECDUS was used for the examination of all 306 cases before EIS and 3-5 months after EIS. ECDUS was performed to evaluate flow in the left gastric vein, paraesophageal veins, perforating veins and cardiac intramural veins.

RESULTS

The patients were divided into three groups according to time of esophageal variceal recurrence: early recurrence within one year (Group A, n = 16), no recurrence over three years (Group B, n = 12), and recurrence between one and three years (Group C, n = 278). Before EIS, the frequency of detection of perforating veins and the inflowing type of perforating veins using ECDUS was significantly higher for Group A than Groups B or C. After EIS, the frequency of detection of cardiac intramural veins, perforating veins and the inflowing type of perforating veins using ECDUS was significantly higher in Group A than Groups B or C.

CONCLUSION

Endoscopic ultrasonographic evaluation of the hemodynamics in esophageal varices before and after EIS enables prediction of early variceal recurrence.