Perforating veins in recurrent esophageal varices evaluated by endoscopic color Doppler ultrasonography with a galactose-based contrast agent

Background

We evaluated the usefulness of endoscopic color Doppler ultrasonography (ECDUS) with Levovist, a galactose-based contrast agents, for detecting perforating veins in the esophageal wall in patients with recurrent esophageal varices after endoscopic therapies.

Methods

We compared vessel images detected prior to the use of contrast with those detected by enhanced ECDUS in 29 patients with recurrent esophageal varices. After the pre-contrast ECDUS examination, all 29 patients received Levovist intravenously, at a concentration of 300 mg/ml. A 7.5-ml dose of the contrast agent was injected at a slow infusion rate, of 1 ml/min. The perforating veins detected by ECDUS were classified, according to flow direction, into three different types. Type 1 showed inflow from the paraesophageal veins to the esophageal varices. Type 2 showed outflow from the esophageal varices to the paraesophageal veins, while type 3 was a mixed type with both inflow and outflow. For comparison, 26 patients without recurrent esophageal varices were studied.

Results

Color flow images of perforating veins were obtained in 9 (31.0%) of the 29 patients with recurrent esophageal varices with pre-contrast ECDUS. The detection rate of perforating veins in the patients with recurrent esophageal varices (31.0%) was significantly higher than that in patients without recurrent esophageal varices (0 of 26; 0%) with pre-contrast ECDUS. Color flow images of perforating veins were detected in 22 (75.9%) of the 29 patients with recurrent esophageal varices after Levovist contrast. On the other hand, color flow images of perforating veins were not detected in any of the 26 patients without recurrent esophageal varices after Levovist contrast. Type 1 perforating veins were recognized in 6 (20.7%) of the 29 patients, type 2 in 2 (6.9%) of the 29, and type 3 in 1 (3.4%) of the 29 prior to the use of contrast. After the enhanced ECDUS, type 1 perforating veins were recognized in 13 (44.8%) of the 29 patients, type 2 in 6 (20.7%) of the 29, and type 3 in 3 (10.3%) of the 29. All color-flow images detected with pre-contrast ECDUS were enhanced after Levovist contrast.

Conclusions

Perforating veins can be detected at a high rate by ECDUS with Levovist in patients with recurrent esophageal varices after endoscopic therapy.