Abstract
Endoscopic ultrasanography (EUS) was perfarmed in 52 patients with esaphago-gastric varices for selection of the treatment method. EUS findings of esophago-gastricvarices are as follows: 1) intramural vessels, 2) extramural vessels, 3) perforating vein (p.v.), 4) localization of the developed collateral circulation. The maximum diameters of intramural vessels were correlated with F factor ofendoscopic findings. We classified intramural vessels into 4 types (type 0, I, II, III) andextramural vessels into 4 types (type N, S, M, L) according to the maximum diameters ofthe vessels.
The perforating veins were detected in 89%of ail cases.
In 75% of all, the developed bollateral circulation was seen between the middle portionof the esophagus and cardia of the stomach. Four check points of the vascular structureof the esophaga-gastric varices were useful for making a precise diagnosis. The structure of 37 patients (71%) was classified into “ typical pattern” that was a partof upward collaterals from the left gastric vein, and 15 patients (29%) into“ atypicalpattern” .
It was suggested that the treatment method of esophago-gastric varices was chosenwith their structures based on these EUS findings. we concluded; 1) esophago-gastricvarices showing “ typical pattern” which have the maximum diameters of p. v. within 4 mmare indicated for endascopic injection sclerotherapy (EIS) . The varices of “ typical pattern” with the maximum diameters of p. v. over 4 mm sheuld be treated with combined therapy (α -cyanoacrylate monomer:CA or endoscopic variceal ligation:EVL). 2) esophagealvarices showing “atypical pattern” which have few extramural vessels are indicated forEIS, and otherwise should be choiced combined therapy.
3) gastric varices showing “ atypical pattern” which have the maximum diameters ofp.v. within 4 mm are indicated for combined therapy, and in case of the maximumdiameters of p. v. over 4 mm should be chosen surgical therapy or balloon occludedretrograde transvenous obliteration (B-RTO).
EUS is useful fcr selecting endoscepic treatment of esophago-gastric varices.
