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Application of Indian ink markers for locating gastric varices under endoscopic ultrasonography

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Abstract

Objective

The present study aimed to investigate the accuracy of endoscopic ultrasonography (EUS) combined with Indian ink in locating target vessels of gastric varices (GVs) compared with conventional endoscopic techniques. Additionally, the characteristics of GVs under conventional endoscopy were also explored.

Methods

All 50 cirrhotic patients with GVs between August 2021 and December 2022 were included in the study. Firstly, conventional endoscopy was employed to identify GVs and to record the expected injection sites. Subsequently, EUS was used to locate the perforated vessel and the injection site was them marked with India ink followed by injection with cyanoacrylate (CYA). Finally, conventional endoscopy was used to examine GVs, to identify the marker points of Indian ink and to compare whether the injection points under conventional endoscopy were consistent with those marked with Indian ink. Furthermore, patients with consistent and inconsistent distribution of endoscopic markers and injection sites were divided into two groups.

Results

EUS could detect the perforating vessels in real time and intuitively. The distribution of markers using EUS was significantly different compared with the injection points obtained by conventional endoscopy (P < 0.001). Therefore, 20 cases were allocated to the consistent group and 30 cases to the non-consistent group. 16 patients who showed red wale signs were obtained in the consistent group and 11 patients in the non-consistent group (P = 0.048). The diameter of the largest GVs was 13.5 (10–15) mm in the consistent group compared with 10 (7.5–10) mm in the non-consistent group (P = 0.006).

Conclusion

EUS could provide the exact location of GVs, thus more accurately describing the endoscopic characteristics of the GVs. Furthermore, the red wale signs and diameter of the largest GVs obtained using conventional endoscopy were helpful in determining the location of target GVs.

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Acknowledgements

Supported by The sixth batch of health and appropriate technology promotion projects in Anhui Province, new technology of comprehensive diagnosis and treatment of esophagogastric varices under endoscopy (SYJS202103); NSF Project, MAIT Cells induce neutrophil aging through gut microbiota, A novel mechanism for the progression of alcoholic liver disease (82270623).

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Author notes

  1. Zhihong Wang, Fumin Zhang, and Zhuang Zeng have contributed equally to this article.

Authors and Affiliations

  1. Key Laboratory of Digestive Diseases of Anhui Province, Department of Gastroenterology, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, 230022, Anhui, China

    Zhihong Wang, Fumin Zhang, Zhuang Zeng, Yuchuan Bai, Lihong Chen, Chen Shi, Jing Jin, Qianqian Zhang, Xuecan Mei & Derun Kong

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  1. Zhihong Wang
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Correspondence to Xuecan Mei or Derun Kong.

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Zhihong Wang, Fumin Zhang, Zhuang Zeng, Yuchuan Bai, Lihong Chen, Chen Shi, Jing Jin, Qianqian Zhang, Xuecan Mei, Derun Kong have no conflicts of interest or financial ties to disclose.

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Wang, Z., Zhang, F., Zeng, Z. et al. Application of Indian ink markers for locating gastric varices under endoscopic ultrasonography. Surg Endosc 38, 633–639 (2024). https://doi.org/10.1007/s00464-023-10532-w

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