, Volume 35, Issue 1, pp 19-25
Date: 15 Mar 2008

Hemodynamic evaluation by endoscopic ultrasonography of esophageal varices resistant to injection sclerotherapy

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Abstract

Purpose

Some esophageal variceal cases are resistant to endoscopic injection sclerotherapy (EIS) using 5% ethanolamine oleate (5% EO). We evaluated the hemodynamics of esophageal varices that were resistant to EIS using 5% EO.

Methods

Selected for this study were 290 consecutive patients who underwent hemodynamic evaluation using endoscopic color Doppler ultrasonography (ECDUS) and an ultrasonic microprobe (UMP) before EIS. EIS was performed using 5% EO with iopamidol (5% EOI) under fluoroscopy. We retrospectively evaluated the hemodynamic differences between patients resistant to and not resistant to EIS using 5% EOI.

Results

Nine patients were resistant to EIS using 5% EOI (group A). Various parameters were compared between the 281 patients who had been given EIS using 5% EOI for esophageal varices (group B) and the 9 patients in group A. The mean number of EIS treatments until shrinkage of esophageal varices was achieved in group A (6.8 ± 3.4) was significantly greater than that in group B (4.4 ± 2.1) (P < 0.01). The mean amount of 5% EOI used in group A (31.1 ± 17.4 ml) was significantly larger than that used in group B (14.9 ± 8.8 ml) (P < 0.001). The mean frequency shift of esophageal varices in group A (452.9 ± 106.6 Hz) was significantly higher than that in group B (313.0 ± 103.2 Hz) (P < 0.001) as determined by ECDUS. The mean diameter of esophageal varices as found by UMP was 8.0 ± 3.5 mm in group A and 4.6 ± 2.4 mm in group B, with the difference being significant (P < 0.01). Perforating veins inflowing from extramural to intramural regions were recognized in 8 (88.9%) of the 9 patients in group A and in 67 (24.1 %) of the 281 patients in group B. The mean diameter of the perforating vein was 3.8 ± 1.9 mm in group A and 2.1 ± 0.5 mm in group B, as shown by UMP, a difference that was statistically significant (P < 0.01).

Conclusion

Hemodynamic evaluation revealed that the esophageal varices were of a higher grade in group A than in group B. By using ECDUS and UMP, this study shed light on the hemodynamics of esophageal variceal cases resistant to EIS using 5% EOI.