Abstract
Thirty-four patients with gastro-esophageal varices were evaluated from the findings of endoscopic ultrasonography (EUS). The demonstrability of gastric varices on the fornix (fundic varices ; FV) in EUS was superior than that of abdominal angiography or abdominal CT. However the demonstrability of esophageal varices was lower using EUS. Fundic varices (FV) were endoscopically observed in 27 out of the 34 patients. These patients were classified into 3 groups endoscopically ; 9 patients with flat elevated FV, 10 with nodular FV, and 8 with tumorous FV. All the FV were revealed by EUS. The mean diameters of the intramural blood vessels were 3.1 mm, 5.0 mm and 9.1 mm respectively (p < 0.01, x2-test). The perforated blood vessel in tumorous FV cases also significantly larger than as flat elevated or nodular FV cases. These findings suggest that tumorous FV have a richer blood flow. The gastric wall covering the intramural blood vessel was demonstrated as a three-layered structure. The mean thickness from the surface of the first layer to the bottom of the third layer was measured as 2.1 mm. This was tinner than that of the upper three layers in the normal gastric mucosa which measured 3.6 mm (p < 0.01, x2-test). These findings indicate that gastric erosion on the FV may provoke bleeding from the FV. Behind the FV, the normal structure of the gastric wall could not be seen in most of the tumorous FV. Consequently, when an ulcer or necrosis associated with endoscopic injection sclerotherapy is located on the gastric mucosa, perforation or penetration of the gastric wall might be caused. These results clearly demonstrate the usefulness of EUS in making an accurate diagnosis of FV.
