Journal of Gastroenterology

, Volume 41, Issue 1, pp 28–33 | Cite as

Usefulness of electronic radial endoscopic color Doppler ultrasonography in esophageal varices: comparison with convex type

  • Takahiro Sato
  • Katsu Yamazaki
  • Jouji Toyota
  • Yoshiyasu Karino
  • Takumi Ohmura
  • Jun Akaike
  • Yasuaki Kuwata
  • Toshihiro Suga
Article

Abstract

Background

Endoscopic color Doppler ultrasonography (ECDUS) is a method for detecting color flow images in blood vessels. We previously reported on the usefulness of ECDUS (convex-type scanning instruments with forward—oblique viewing) for evaluating the hemodynamics of esophageal varices. In the present study, we report the usefulness of new electronic radial ECDUS in cases of esophageal varices by comparison with convex-type ECDUS.

Methods

Twenty-six patients with esophageal varices were identified and studied. The underlying pathologies of portal hypertension included liver cirrhosis (15 patients) and cirrhosis associated with hepatocellular carcinoma (11 patients). Endoscopic findings of esophageal varices were as follows: Cb, F3, and Ls varices in four patients; Cb, F2, and Lm varices in 21 patients; and Cb, Lm, and F1 varices in one patient. RC1 was observed in the esophagus in 14 of the 26 patients. RC2 was noted in 11 cases, and RC0 was seen in one patient. ECDUS was performed using a Pentax EG-3630UR (forward view) with a distal tip diameter of 12 mm. The instrument (electronic radial array) has a curved array scanning transducer with variable frequency (5.0, 7.5, 10.0 MHz). A Hitachi EUB 6500,8500 was used for the display, providing 270° images. We monitored the color flow images of esophageal varices, paraesophageal veins, palisade veins, perforating veins, and pulsatile waves using this technique. As a control, 110 patients were examined by convex-type ECDUS.

Results

(1) Color flow images of esophageal varices and paraesophageal veins were obtained in 26 of the 26 patients, whereas color flow images of perforating veins were obtained in 18 of the 26 patients (69.2%). Color flow images of palisade veins were obtained in 12 of the 26 patients (46.2%). (2) Color flow images of pulsatile waves were obtained in 10 of the 26 patients (38.5%). Color flow images of pulsatile waves were detected in zero (0%) of the 4 F3 varices, in nine (42.9%) of the 21 F2 varices, and in the 1 (100%) case of F1 varices. Also, color flow images of pulsatile waves were detected in seven (50.0%) of the 14 RC1 varices, in two (18.2%) of the 11 RC2 varices, and in the 1 (100%) case of RC0 varices. (3) As a control, 110 patients were examined by convex-type ECDUS. Color flow images of esophageal varices and paraesophageal veins were obtained in 110 of the 110 patients, whereas color flow images of perforating veins were obtained in 74 of 110 (67.3%) with convex-type ECDUS. The detection rate of palisade veins with electronic radial ECDUS (12 of the 26 patients, 46.2%) was significantly higher than with convex-type ECDUS (28 of the 110 patients, 25.5%) (P < 0.05). The detection rate of pulsatile waves with electronic radial ECDUS (10 of the 26 cases, 38.5%) was significantly higher than with convex-type ECDUS (3 of the 110 cases, 2.7%) (P < 0.0001).

Conclusions

Electronic radial ECDUS provides clear color flow images of blood vessels in esophageal varices with the additional advantages of forward-view optics and extended 270° views. Electronic radial ECDUS was superior to convex-type ECDUS in detecting palisade veins and pulsatile waves.

Key words

esophageal varices endoscopic ultrasonography color Doppler electronic radial ECDUS hemodynamics 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sato, T, Higashino, K, Murashima, Y, Suga, T, Yaosaka, T, Imamura, A,  et al. 1994An application of endoscopic color Doppler ultrasonography (ECDUS) in the diagnosis of hemodynamics of gastric varices, and the therapeutic effect of endoscopic therapyDig Endosc632633Google Scholar
  2. 2.
    Sato, T, Higashino, K, Toyota, J, Karino, Y, Omura, T, Murashima, Y,  et al. 1996The usefulness of endoscopic color Doppler ultrasonography in the detection of perforating veins of esophageal varicesDig Endosc81803Google Scholar
  3. 3.
    Sato, T, Yamazaki, K, Toyota, J, Karino, Y, Ohmura, T, Suga, T 1999Perforating veins in recurrent esophageal varices after endoscopic therapy visualized by endoscopic color Doppler ultrasonographyDig Endosc1123640Google Scholar
  4. 4.
    Sato, T, Yamazaki, K, Toyota, J, Karino, Y, Ohmura, T, Suga, T 2003Evaluation of hemodynamics in esophageal varices: value of endoscopic color Doppler ultrasonography with a galactose-based contrast agentHepatol Res255561PubMedGoogle Scholar
  5. 5.
    Japanese Research Society for Portal Hypertension1991The general rules for recording endoscopic findings of esophageal varices—revised edition (in Japanese with English abstract)Acta Hepatol Jpn3327781Google Scholar
  6. 6.
    Caletti, GC, Brocchi, E, Baraldini, M, Ferrari, A, Gibilara, M, Benbara, L 1990Assessment of portal hypertension by endoscopic ultrasonographyGastrointest Endosc36217Google Scholar
  7. 7.
    McCormack, TT, Rose, JD, Smith, PM, Johnson, AG 1983Perforating veins and blood flow in oesophageal varicesLancet214424PubMedGoogle Scholar
  8. 8.
    Hashizume, M, Kitano, S, Sugimachi, K, Sueishi, K 1988Three-dimensional view of the vascular structure of the lower esophagus in clinical portal hypertensionHepatology814827PubMedGoogle Scholar
  9. 9.
    Vianna, A, Hayes, PC, Moscoso, G, Driver, M, Portmann, B, Westaby, D,  et al. 1987Normal venous circulation of the gastroesophageal junction. A route to understanding varicesGastroenterology9387689PubMedGoogle Scholar
  10. 10.
    Kubara, K, Shijo, H, Arakawa, M 1993A clinicopathological study of esophageal varices: relevance to the structure of drainage vessels from esophageal varices (in Japanese with English abstract)Acta Hepatol Jpn3486873Google Scholar
  11. 11.
    Choudhuri, G, Dhiman, RK, Agarwal, DK 1996Endosonographic evaluation of the venous anatomy around the gastro-esophageal junction in patients with portal hypertensionHepatogastroenterology4312505PubMedGoogle Scholar
  12. 12.
    Irisawa, A, Obara, K, Sakamoto, H, Takiguchi, F, Tojo, J, Saito, A,  et al. 1997The selection and evaluation of the manipulation for endoscopic injection sclerotherapy against esophageal varices with extraesophageal shunt (in Japanese)Nihon Monmyakuatsu Koshinsho Gakkai Zasshi314754Google Scholar
  13. 13.
    Saito, A, Obara, K, Irisawa, A, Takiguchi, F, Tojo, J, Ito, M,  et al. 1997Experience of endoscopic injection sclerotherapy combined with selective endoscopic variceal ligation in 3 patients with esophageal varices accompanied by large extra-esophageal shunt (in Japanese)Nihon Monmyakuatsu Koshinsho Gakkai Zasshi32638Google Scholar
  14. 14.
    Sato, T, Yamazaki, K, Toyota, J, Karino, Y, Ohmura, T, Kuwata, Y,  et al. 2003Visualization of palisade veins in esophageal varices by endoscopic color Doppler ultrasonographyDig Endosc158792Google Scholar
  15. 15.
    Inokuchi, K, Kobayashi, M, Saku, M, Nagasue, N, Iwaki, A, Nakayama, S 1977Characteristics of splanchnic portal circulation in portal hypertension as analyzed by pressure study in clinical cases (in Japanese with English abstract)Acta Hepatol Jpn188918Google Scholar
  16. 16.
    Aoki, H 1991The hemodynamics and the treatment of esophago-gastric varices (in Japanese with English abstract)Dig Surg Jpn24230919Google Scholar
  17. 17.
    Sato, T, Yamazaki, K, Toyota, J, Karino, Y, Ohmura, T, Akaike, J,  et al. 2005Evaluation of arterial blood flow in esophageal varices via endoscopic color Doppler ultrasonography with a galactose-based contrast agentJ Gastroenterol40649PubMedGoogle Scholar
  18. 18.
    Sato, T, Yamazaki, K, Toyota, J, Karino, Y, Ohmura, T, Akaike, J,  et al. 2003Experience with electronic radial endoscopic color Doppler ultrasonography esophageal variceal patientsDig Endosc152759Google Scholar
  19. 19.
    Anderson, MA, Scheiman, JM 2002Initial experience with an electronic radial array echoendoscope: randomized comparison with a mechanical sector scanning echoendoscope in humansGastrointest Endosc565737CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2006

Authors and Affiliations

  • Takahiro Sato
    • 1
  • Katsu Yamazaki
    • 1
  • Jouji Toyota
    • 1
  • Yoshiyasu Karino
    • 1
  • Takumi Ohmura
    • 1
  • Jun Akaike
    • 1
  • Yasuaki Kuwata
    • 1
  • Toshihiro Suga
    • 1
  1. 1.Department of GastroenterologySapporo Kosei General HospitalSapporoJapan

Personalised recommendations