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The Role of Endoscopic Ultrasonography for Esophagogastric Varices

  • Atsushi IrisawaEmail author
  • Goro Shibukawa
  • Ai Sato
  • Akane Yamabe
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Abstract

In patients with esophageal varices accompanied by complicating portal hypertension, a large network of portal-systemic collateral veins develops. Endoscopic ultrasonography (EUS), especially ultrasound mini-probe, allows for noninvasive imaging of collateral circulation in the esophagus as well as the inside and outside of the gastric wall and allows treatment selection tailored to the hemodynamics of each individual varix. The characteristics to be evaluated in a patient with esophagogastric varices with EUS include the following: (1) diameter of the varix, (2) perforating veins, (3) periesophageal veins/perigastric veins, and (4) paraesophageal veins/paragastric veins. The observation of these structures provides important information for safer and more effective treatments; in addition, EUS also provides information that is useful for the prediction of recurrence.

Keywords

EUS Esophageal varices Gastric varices 
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References

  1. 1.
    Widrich WC, Srinivasan M, Semine C, et al. Collateral pathways of the left gastric vein in portal hypertension. Am J Roentgenol. 1984;142:375–82.CrossRefGoogle Scholar
  2. 2.
    Bengmark S, Borjesson B, Hoevels J, et al. Obliteration of esophageal varices by PTP. Ann Surg. 1979;190:549–54.CrossRefGoogle Scholar
  3. 3.
    Hashizume M, Kitano S, Sugimachi K, et al. Three- dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension. Hepatology. 1988;8:1482–7.CrossRefGoogle Scholar
  4. 4.
    Frederick HM, Clements JL, Colvin RS. Retrocardiac densities due to paraesophageal varices: roentgenographic detection. South Med J. 1985;78:1371–2.CrossRefGoogle Scholar
  5. 5.
    Caletti GC, Brocchi E, Ferrari A, et al. Value of endoscopic ultrasonography in the management of portal hypertension. Endoscopy. 1992;24:342–6.CrossRefGoogle Scholar
  6. 6.
    Irisawa A, Obara K, Sato Y, et al. An endoscopic analysis of collateral veins inside and outside the esophageal wall in portal hypertension. Gastrointest Endosc. 1999;50:374–80.CrossRefGoogle Scholar
  7. 7.
    Kassem MA, Salama AZ, Rosch T. Endoscopic ultrasonography in portal hypertension. Endoscopy. 1997;29:399–406.CrossRefGoogle Scholar
  8. 8.
    Irisawa A, Shibukawa G, Obara K, et al. Collateral vessels around the esophageal wall in patients with portal hypertension: comparison of EUS imaging and microscopic findings at autopsy. Gastrointest Endosc. 2002;56:249–53.CrossRefGoogle Scholar
  9. 9.
    Nakamura S, Murata Y, Mitsunaga A, et al. Hemodynamics of esophageal varices on three-dimensional endoscopic ultrasonography and indication of endoscopic variceal ligation. Dig Endosc. 2003;15:289–97.CrossRefGoogle Scholar
  10. 10.
    Sato T, Yamazaki K, Toyota J, et al. Clinical experience with newer electronic radial-type endoscopic color Doppler ultrasonography in the diagnosis of esophageal varices. J Med Ultrason 2001. 2010;37:117–21.CrossRefGoogle Scholar
  11. 11.
    The general rules for study of portal hypertension. 3rd ed. Kanehara-Shuppan: The Japanese Society for Portal Hypertension; 2013. p. 41–2.Google Scholar
  12. 12.
    Irisawa A, Obara K, Bhutani M, et al. Role of para-esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis. J Gastroenterol Hepatol. 2003;18:309–14.CrossRefGoogle Scholar
  13. 13.
    Sato T, Higashino K, Toyota J, et al. The usefulness of endoscopic color Doppler ultrasonography in the detection of perforating veins of esophageal varices. Dig Endosc. 1996;8:180–3.Google Scholar
  14. 14.
    Irisawa A, Saito A, Obara K, et al. Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities: severe periesophageal collateral veins and large perforating veins. Gastrointest Endosc. 2001;53:77–84.CrossRefGoogle Scholar
  15. 15.
    Imamura H, Irisawa A, Shibukawa G, et al. Echo-endoscopic analysis of variceal hemodynamics in patient with isolated gastric varices. Endosc Ultrasound. 2014;3:238–44.CrossRefGoogle Scholar
  16. 16.
    Wakatsuki T, Obara K, Irisawa A, et al. Analysis of prognostic factors in patient with gastric varices after endoscopic treatment. Dig Endosc. 2009;21:232–8.CrossRefGoogle Scholar
  17. 17.
    Irisawa A, Obara K, Sato Y, et al. Adherence of cyanoacrylate which leaked from gastric varices to the left renal vein during injection sclerotherapy: a histopathologic study. Endoscopy. 2000;32:804–6.CrossRefGoogle Scholar
  18. 18.
    Bhatia V. Endoscopic ultrasound (EUS) for esophageal and gastric varices: how can it improve the outcomes and reduce complications of glue injection. J Clin Exp Hepatol. 2012;2:70–4.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Atsushi Irisawa
    • 1
    Email author
  • Goro Shibukawa
    • 1
  • Ai Sato
    • 1
  • Akane Yamabe
    • 1
  1. 1.Department of GastroenterologyAizu Medical Center, Fukushima Medical UniversityAizuwakamatsuJapan

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