Objective: To determine whether differences in the perfusion pattern in the liver parenchyma visualized by sonazoid-enhanced ultrasonography (S-US) is useful in predicting the incidence of portal hypertension-associated complications.
Materials and Methods: A total of 253 patients with type C chronic liver disease underwent S-US evaluation using Toshiba Aplio XG ultrasound system to obtain enhancement patterns in the S5 region of the liver and the right kidney through right intercostal scanning which took 30s after intravenous infusion of sonazoid. Captured video was processed to create the Parametric Images, which enabled the evaluation of perfusion patterns in the liver parenchyma by color visualization. Obtained perfusion patterns were assessed in relation to the incidence of complications of portal hypertension.
Results: Perfusion patterns were classified into 3 patterns depending on whether the liver parenchyma was perfused mainly by the portal vein (pattern P), equivalently by the portal vein and hepatic artery (pattern AP) or mainly by the hepatic artery (pattern A). Compared to pattern P, patterns AP and A were observed significantly more frequently in patients with esophageal varix and in those with splenomegaly (p < 0.01). Pattern P was not observed in any of the patients with ascites, while patterns AP and A were observed significantly more frequently in these patients (p < 0.01).
Conclusion: The Parametric Imaging was useful in predicting the incidence of complications associated with portal hypertension.

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From 1986 through 2007, endoscopic injection sclerotherapy (EIS) was performed in 67 patients with gastric varices. The total number of treatment sessions was 213: emergency treatment, 16; elective treatment, 125; and prophylactic treatment, 72. Hemostasis was successfully achieved by EIS with Histoacryl blue^® in all patients who received emergency treatment. Good outcomes were also obtained in patients who underwent elective treatment and prophylactic treatment. The rate of recurrent bleeding was low.
Esophageal varices may occur together with gastric varices. These varices serve as a collateral shunt from the portal venous system to the azygos vein and superior vena cava and drain into the left renal vein and inferior vena cava through the adrenal vein. Therefore, gastric varices should be treated at the same time as esophageal varices whenever possible.
Sclerotherapy for gastric varices should be performed cautiously, bearing in mind that some varices have a rapid flow rate and large blood volume and that that blood flow cannot be blocked with an endoscopic balloon.
EIS with sclerosants and Histoacryl is usually performed for the emergency treatment of actively bleeding gastric varices. EIS is also useful as follow-up treatment to ensure complete eradication of varices. It is important to completely eradicate gastric varices. The goals of treatment for gastric varices are complete eradication and the prevention of recurrence, similar to esophageal varices.

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Effect of endoscopic therapy was compared with interventional radiologic (IVR) therapy on gastric varices (GV) using 99 patients with GV. Of these, 55 patients were selected for endoscopic treatment, 34 were selected for IVR therapy and 10 were selected for the combination of both treatment. Among them 51% of the patients received prophylactic, 36% received emergent, and 13% received electic treatment.
Disappearance rates of GV after treatment were both comparably high at 94.5% in patients receiving endoscopic therapy and 91.2% in patients receiving IVR therapy, respectively. The recurrence-free interval was significantly longer in the prophylactic cases than the other cases (p < 0.05). In the prophylactic cases the recurrence-free period was significantly longer in patients who underwent IVR therapy than those who received endoscopical treatment. (p < 0.05: hazard ratio, 5.8).
In the emergent and elective patients a recurrence-free interval was significantly shorter in those who required blood transfusion than those who didn't (p < 0.05, hazard ratio, 4.2).
Survival time was significantly shorter in patients who were complicated with hepatocellular carcinoma (p < 0.0001; hazard ratio, 11.5) and in patients with poor hepatic function (p < 0.0001; hazard ratio, 7.8). There was no significant difference in the survival time between the two treatments in currently bleeding patients, suggesting that either therapy can be selected in such cases. Proplylactic IVR therapy before the worsening of hepatic function may attain a longer recurrence-free period.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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