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EFFECT OF ENDOSCOPIC VARICEAL LIGATION FOR ESOPHAGEAL VARICES: VASCULAR STRUCTURE IMAGES BY MINIATURE ULTRASOUND PROBE
Author(s) -
Nakano Shigeru,
Hachiya Akihiko
Publication year - 2005
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2005.00501.x
Subject(s) - medicine , esophageal varices , ligation , varices , esophagus , gastric varices , portal hypertension , endoscopic ultrasound , varix , endoscopy , gastroenterology , radiology , cirrhosis
Background: The effect of eradication of esophageal varices on the collateral veins beside the esophagogastric junction in portal hypertensive patients remains unclear. Methods: The intramural and extramural vascular structures of the cardia and lower esophagus of 35 patients with portal hypertension were examined by endoscopic ultrasonography (EUS) before and after treatment of esophageal varices with endoscopic variceal ligation (EVL), in which ligations were repeatedly performed until complete obliteration of the varices. The vascular structures were classified into the gastric, palisade/perforating (p/p), and truncal zones, and were quantitatively evaluated. Results: No esophageal varices remained in the p/p nor in the truncal zones after EVL. EVL significantly reduced the total cross‐sectional area (CSA) of the submucosal vessels and number of perforating veins in the gastric zone ( P < 0.01, P < 0.01), and the total CSA of the peri‐esophageal collateral veins (peri‐ECV) and number of perforating veins in the p/p zone ( P < 0.001, P < 0.001). Furthermore, the total CSA of the peri‐ECV was larger among patients with perforating veins in the p/p zone than among those without, both before and after EVL. Conclusions: EVL obliterated esophageal varices, and indirectly influenced the intramural and extramural vascularities in the region of the esophagogastric junction, which may contribute to prevention of variceal recurrence.