Abstract
With respect to the anatomical vasculature at the lower esophagus, esophageal varices are classified into two types of vascular pattern ; palisading and pipeline stem. The majority of esophageal varices are fed by palisading veins from 3-5 cm long upwards from the squamo-columnar (S-C) junction, while the pipeline varix has no palisade veins but has a single pipeline stem vein (varix). The pipeline varix is large and forms a single vessel starting from the gastric cardia on the lesser curvature, running high up to the esophagus without change of variceal size at S-C junction. The pipeline varix is further classified into two types ; a typical type in which an ascending esophageal varix starts from the gastric cardia on the lesser curvature (gastric cardiac varices), and a subtype in which an F2 or larger ascending varix abruptly appears at the lower esophageal wall at 1- to 2 cm to the oral side from the S-C junction without gastric cardiac varices. The diagnosis of both types of pipeline varix can be made by endoscopy and confirmed by percutaneous transhepatic portography, endoscopic varicealography during injection sclerotherapy and/or endoscopic ultrasonography. Endoscopic injection sclerotherapy with ligation (EISL) is a safe and effective therapy for pipeline varices, but it is refractory and risky when treated with endoscopic variceal ligation alone without diagnosis of the pipeline varix.
