Abstract
For the safe and effective treatment of esophageal varices with endoscopic injection sclerotherapy, the lesion was hemodynamically classified based on an anatomical analysis of the collateral circulation by multi-detector-row computed tomography (MD-CT). Forty-nine patients with esophageal varices having a blood supply from the left gastric vein (LGV) served as the subjects of this study. Following a hemodynamic study based on MD-CT, a 3D-CT (three-dimensional computed tomography) image was produced for the collateral circulation. The hemodynamics of the para-esophageal vein (PEV) were classified into the following 3 types : type I, without PEV ; type II, PEV that had developed with its diameter being equal to or less than the diameter of the esophageal varix ; and type III, where the PEV had a diameter greater than the esophageal varix. Thirteen, 20 and 16 cases accounted for types I, II and III, respectively. In 18 cases, postoperative complications or recurrences were seen in the perforating veins. For treatment, embolization must be extended to the root of the LGV in type I ; in types II and III, embolization up to where the LGV branches off will suffice. In type III, in particular, an excess of sclerosing agent may be injected unless the site where LGV branches is visualized. This type represents the hemodynamics state that requires the closest attention. Hemodynamic classification based on the PEV is highly useful in formulating safe and effective therapeutic strategies.
