Abstract
Background
Our preliminary study indicated that either a high hepatofugal flow velocity in the left gastric vein (LGV) or an anterior branch dominant pattern seen under color Doppler EUS (CD-EUS) were possible contributing risk factors for variceal recurrence after endoscopic treatment. However, the sample size was too small, and in this study we aimed to validate the results of the preliminary study.
Methods
Sixty-eight patients treated for moderate or large esophageal varices between 2001 and 2004 at a single university hospital were enrolled in this study. CD-EUS was followed by endoscopic variceal ligation and sclerotherapy.
Results
Patients were classified into either a high-risk group, which exhibited anterior branch dominance and flow velocity of 12 cm/s or more, or a low-risk group, which included all other patients. Half of the patients in the high-risk group exhibited a recurrence within half a year, whereas it took almost 2 years for half of the patients in the other group to exhibit a recurrence (P = 0.0044). Using the Cox proportional hazard model with multivariate analysis, only the features of the high-risk group were significant in triggering recurrence of varices (hazard ratio [HR], 3.00; 95% confidence interval [CI], 1.35–6.65; P < 0.001).
Conclusions
These results suggest that patients showing anterior branch dominance and rapid hepatofugal flow velocity in the LGV on CD-EUS examination may have a high risk of an early recurrence of esophageal varices.
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References
GV Stiegmann JS Goff PA Michaletz-Onody J Korula D Lieberman ZA Saeed et al. (1992) ArticleTitleEndoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices N Engl J Med 326 1527–32 Occurrence Handle1579136 Occurrence Handle1:STN:280:DyaK383lt1yktg%3D%3D Occurrence Handle10.1056/NEJM199206043262304
D Westaby PC Hayes AE Gimson RJ Polson R Williams (1989) ArticleTitleControlled clinical trial of injection sclerotherapy for active variceal bleeding Hepatology 9 274–7 Occurrence Handle2492252 Occurrence Handle10.1002/hep.1840090219 Occurrence Handle1:STN:280:DyaL1M7gvVejtA%3D%3D
AE Gimson JK Ramage MZ Panos K Hayllar PM Harrison R Williams et al. (1993) ArticleTitleRandomised trial of variceal banding ligation versus injection sclerotherapy for bleeding oesophageal varices Lancet 342 391–4 Occurrence Handle8101900 Occurrence Handle10.1016/0140-6736(93)92812-8 Occurrence Handle1:STN:280:DyaK3szktFaisg%3D%3D
M Hashizume S Kitano N Koyanagi K Tanoue M Ohta H Wada et al. (1992) ArticleTitleEndoscopic injection sclerotherapy for 1000 patients with esophageal varices: a 9-year prospective study Hepatology 15 69–75 Occurrence Handle1727802 Occurrence Handle10.1002/hep.1840150114 Occurrence Handle1:STN:280:DyaK38%2FptV2kuw%3D%3D
MC Hou HC Lin BI Kuo CH Chen FY Lee SD Lee (1995) ArticleTitleComparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial Hepatology 21 1517–2 Occurrence Handle7768494 Occurrence Handle1:STN:280:DyaK2M3os1WgsQ%3D%3D
L Laine C Stein V Sharma (1996) ArticleTitleRandomized comparison of ligation versus ligation plus sclerotherapy in patients with bleeding esophageal varices Gastroenterology 110 529–33 Occurrence Handle8566601 Occurrence Handle10.1053/gast.1996.v110.pm8566601 Occurrence Handle1:STN:280:DyaK287ls1SmtA%3D%3D
ZA Saeed GV Stiegmann FC Ramirez RM Reveille JS Goff KS Hepps et al. (1997) ArticleTitleEndoscopic variceal ligation is superior to combined ligation and sclerotherapy for esophageal varices: a multicenter prospective randomized trial Hepatology 25 71–4 Occurrence Handle8985267 Occurrence Handle10.1002/hep.510250113 Occurrence Handle1:STN:280:DyaK2s7jvVansw%3D%3D
GH Lo KH Lai JS Cheng CK Lin JS Huang PI Hsu et al. (1998) ArticleTitleThe additive effect of sclerotherapy to patients receiving repeated endoscopic variceal ligation: a prospective, randomized trial Hepatology 28 391–5 Occurrence Handle9696002 Occurrence Handle10.1002/hep.510280215 Occurrence Handle1:STN:280:DyaK1czlvFWksQ%3D%3D
Y Takase S Shibuya F Chikamori K Orii Y Iwasaki (1990) ArticleTitleRecurrence factors studied by percutaneous transhepatic portography before and after endoscopic sclerotherapy for esophageal varices Hepatology 11 348–52 Occurrence Handle2312049 Occurrence Handle10.1002/hep.1840110303 Occurrence Handle1:STN:280:DyaK3c7osFGltg%3D%3D
G Caletti E Brocchi M Baraldini A Ferrari M Gibilaro L Barbara (1990) ArticleTitleAssessment of portal hypertension by endoscopic ultrasonography Gastrointest Endosc 36 S21–7 Occurrence Handle2184082 Occurrence Handle1:STN:280:DyaK3c3ivVOmtg%3D%3D
K Ziegler M Gregor M Zeitz T Zimmer F Habermann EO Riecken (1991) ArticleTitleEvaluation of endosonography in sclerotherapy of esophageal varices Endoscopy 23 247–50 Occurrence Handle1743122 Occurrence Handle1:STN:280:DyaK38%2Fns12hsw%3D%3D Occurrence Handle10.1055/s-2007-1010678
G Choudhuri RK Dhiman DK Agarwal (1996) ArticleTitleEndosonographic evaluation of the venous anatomy around the gastro-esophageal junction in patients with portal hypertension Hepatogastroenterology 43 1250–5 Occurrence Handle8908559 Occurrence Handle1:STN:280:DyaK2s%2FmsFSjuw%3D%3D
S Hino H Kakutani K Ikeda Y Uchiyama K Sumiyama A Kuramochi et al. (2002) ArticleTitleHemodynamic assessment of the left gastric vein in patients with esophageal varices with color Doppler EUS: factors affecting development of esophageal varices Gastrointest Endosc 55 512–7 Occurrence Handle11923763 Occurrence Handle10.1067/mge.2002.122333
S Hino H Kakutani K Ikeda H Yasue Y Kitamura K Sumiyama et al. (2001) ArticleTitleHemodynamic analysis of esophageal varices using color Doppler endoscopic ultrasonography to predict recurrence after endoscopic treatment Endoscopy 33 869–72 Occurrence Handle11571684 Occurrence Handle10.1055/s-2001-17339 Occurrence Handle1:STN:280:DC%2BD3MrisVWltA%3D%3D
Y Idezuki (1995) ArticleTitleGeneral rules for recording endoscopic findings of esophagogastric varices (1991). Japanese Society for Portal Hypertension World J Surg 19 420–2 Occurrence Handle7638999 Occurrence Handle10.1007/BF00299178 Occurrence Handle1:STN:280:DyaK2Mzms1ajuw%3D%3D
RN Pugh IM Murray-Lyon JL Dawson MC Pietroni R Williams (1973) ArticleTitleTransection of the oesophagus for bleeding oesophageal varices Br J Surg 60 646–9 Occurrence Handle4541913 Occurrence Handle10.1002/bjs.1800600817 Occurrence Handle1:STN:280:DyaE3s3jsVWqsw%3D%3D
A Matsumoto N Hamamoto A Ohnishi H Miyoshi K Sugi H Kojima et al. (1999) ArticleTitleLeft gastric vein hemodynamics and variceal recurrence in patients undergoing prophylactic endoscopic ligation of high-risk esophageal varices Gastrointest Endosc 50 768–74 Occurrence Handle10570334 Occurrence Handle10.1016/S0016-5107(99)70156-2 Occurrence Handle1:STN:280:DC%2BD3c%2FktVahtg%3D%3D
GH Lo HL Liang KH Lai CF Chang JH Hwu SM Chen et al. (1996) ArticleTitleThe impact of endoscopic variceal ligation on the pressure of the portal venous system J Hepatol 24 74–80 Occurrence Handle8834028 Occurrence Handle10.1016/S0168-8278(96)80189-9 Occurrence Handle1:STN:280:DyaK28vjtV2ntA%3D%3D
L Cipolletta MA Bianco G Rotondano R Marmo C Meucci R Piscopo (2002) ArticleTitleArgon plasma coagulation prevents variceal recurrence after band ligation of esophageal varices: preliminary results of a prospective randomized trial Gastrointest Endosc 56 467–71 Occurrence Handle12297759 Occurrence Handle10.1016/S0016-5107(02)70428-8
S Hino H Kakutani K Ikeda H Yasue K Sumiyama Y Uchiyama et al. (2001) ArticleTitleLow power diode laser treatment using indocyanine green for eradication of esophageal varices Endoscopy 33 873–5 Occurrence Handle11571685 Occurrence Handle10.1055/s-2001-17341 Occurrence Handle1:STN:280:DC%2BD3MrisVWltQ%3D%3D
RK Dhiman G Choudhuri VA Saraswat DK Agarwal SR Naik (1996) ArticleTitleRole of paraoesophageal collaterals and perforating veins on outcome of endoscopic sclerotherapy for oesophageal varices: an endosonographic study Gut 38 759–64 Occurrence Handle8707125 Occurrence Handle1:STN:280:DyaK28zjsV2ksg%3D%3D
JM Pontes MC Leitao F Portela A Nunes D Freitas (2002) ArticleTitleEndosonographic Doppler-guided manometry of esophageal varices: experimental validation and clinical feasibility Endoscopy 34 966–72 Occurrence Handle12471540 Occurrence Handle10.1055/s-2002-35840 Occurrence Handle1:STN:280:DC%2BD38jgvV2nsA%3D%3D
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Kuramochi, A., Imazu, H., Kakutani, H. et al. Color Doppler endoscopic ultrasonography in identifying groups at a high-risk of recurrence of esophageal varices after endoscopic treatment. J Gastroenterol 42, 219–224 (2007). https://doi.org/10.1007/s00535-006-1992-x
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DOI: https://doi.org/10.1007/s00535-006-1992-x