Abstract
Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are known to be equally effective for the treatment of esophageal varices. However, indications for each therapy have not been established. Endoscopic ultrasonography (EUS) is a well-accepted procedure for the diagnosis of gastrointestinal lesions, and 3-dimensional imaging has recently been developed. In this study, 3-dimensional EUS (3D-EUS) was used to observe hemodynamics of esophageal varices. The aim of this study was to determine the value of 3D-EUS for selecting patients for endoscopic treatment of esophageal varices. 3D-EUS was performed with a 3D ultrasound image system (EU-M30, EU-IP-2, Olympus Co., Ltd.) using a small probe (12 MHz, 3.4 mm in diameter) according to the mechanical spiral scan method (length 40 mm and pitch 0.5 mm) Varices detected on 3D images were classified according to their architecture as a cardia-inflow type without collateral vessels (type 1), a cardia-inflow type with collateral vessels (type 2), an azygos-perforating type (type 3) and a complicated type (type 4). 3D-EUS was carried out in 32 patients with esophageal varices before the treatment with EIS in 22 patients and with EVL in 10 patients respectively. Then, short-term results were assessed. Fourteen patients (43.8%) were classified as type 1, 4 patients (12.5%) were as type 2, 4 patients (12.5%) were as type 3 and 10 patients (31.3%) were as type 4 according to 3D images. In type 1 better therapeutic results was obtained with EIS than with EVL. In type 3 the numbers of session required to obtain eradication was significantly smaller with EVL than with EIS. Thus, 3D-EUS is useful for the selection of methods of endoscopic treatment for esophageal varices. The azygos-perforating type (type 3) is suggested to be the best indication for EVL by sending the variceal blood flow to collateral pathways.
