ENDOSCOPIC ULTRASONOGRAPHIC OBSERVATION OF ESOPHAGEAL VARICES AND THEIR COLLATERAL VESSELS DURING THE NON-SHUNTING OPERATION

Abstract

During the non-shunting operation for esophageal varices in 8 cases of portal hyperten-sion (liver cirrhosis 6, idiopathic portal hypertension 2), we have investigated collateral circulation and esophageal varices with Endoscopic Ultrasonography (EUS). Continuous observation of intraoperative EUS from stomach to upper mediastinum clearly visualized the fornical varices gathered from the short gastric veins, the cardiac varices from the left gastric veins, the anastomosis of esophageal varices and extrinsic paraesophageal vessels. Most of the extrinsic paraesophageal vessels existed between 33 cm and 41 cm from the fore-teeth. The course of the dilated azygos vein is also detected easily from 37 cm from the fore-teeth up to the azygos arch. After the devascularization and transection of the esophagus, extrinsic collateral vessels and esophageal varices are diminished and the azygos vein is narrowed in size. EUS will become a useful technique in the study of collateral circulation of portal hypertension and will be necessary for determing the indication or the way of treatment.