Estimation of feeding vessels of esophageal varices based on the clockwise direction of varices

Abstract

Possibility to identify feeding vessels of esophageal varices based on endoscopic findings of varices was evaluated. Subjects were 124 patients receiving EIS with EO or EISL monotherapy, and the frequency of each feeding vessel was evaluated depending on location of esophageal varices on clockwise direction. The lest gastric vain was identified as a feeding vessel of varices located in all clockwise directions of the esophagus, while was seen especially frequent in patients with varices located from the anterior to left walls of the esophagus. In contrast, the posterior gastric vain was identified as a feeding vessel especially in patients with varices located on the left wall of the esophagus. Consequently, he feeding vessels were the left gastric vein in 111 patients (90%), the posterior gastric vein in 9 patients (7%), and the left gastric vein plus posterior gastric vein in 4 patients (3%), suggesting that the main feeding vessel of esophageal varices was the left gastric vein followed by the posterior gastric vein. These data suggest that possible feeding vessels may be estimated based on the clockwise direction of esophageal varices. Our observation may contribute to establish therapeutic strategy for esophageal varices, since feeding vessels in which EO is injected during the EIS procedure can be identified based on endoscopic findings of esophageal varices.