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. 1996 May;38(5):759–764. doi: 10.1136/gut.38.5.759

Role of paraoesophageal collaterals and perforating veins on outcome of endoscopic sclerotherapy for oesophageal varices: an endosonographic study.

R K Dhiman 1, G Choudhuri 1, V A Saraswat 1, D K Agarwal 1, S R Naik 1
PMCID: PMC1383161  PMID: 8707125

Abstract

BACKGROUND--Endoscopic sclerotherapy (EST) is an established method for controlling and preventing bleeding from oesophageal varices. However, oesophageal varices sclerose easily and require less sessions of EST in some patients while few fail to respond. This study therefore looked at changes in the vascular anatomy of the lower oesophagus and upper stomach that accompany successful sclerotherapy of oesophageal varices. METHODS--Endoscopic ultrasonography was performed in 50 patients with cirrhotic portal hypertension before (control, 20 patients) and after successful obliteration of varices with endoscopic sclerotherapy in a group of responders (EST-R, 20 patients) and in a group of non-responders (EST-NR, 10 patients). RESULTS--The median number and size of submucosal veins at the gastrooesophageal junction and in the lower oesophagus were significantly less in the EST-R group compared with control and EST-NR groups (p values between < 0.00001 and < 0.000001). Concomitantly, the number and size of paraoesophageal collaterals were significantly less in the EST-R group compared with the other two groups (p values between 0.02 and 0.00007). Perforating veins were identified in 14 (70%) patients in the control group, nine (90%) in the EST-NR group and in none in the EST-R group (p < 0.001 for both controls v EST-R and EST-R v EST-NR, and p = NS, control v EST-NR). CONCLUSION--Oesophageal variceal sclerosis is associated with significant reduction in the number and size of paraoesophageal collaterals and disappearance of perforating veins in the lower oesophagus.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BUTLER H. The veins of the oesophagus. Thorax. 1951 Sep;6(3):276–296. doi: 10.1136/thx.6.3.276. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Balthazar E. J., Naidich D. P., Megibow A. J., Lefleur R. S. CT evaluation of esophageal varices. AJR Am J Roentgenol. 1987 Jan;148(1):131–135. doi: 10.2214/ajr.148.1.131. [DOI] [PubMed] [Google Scholar]
  3. Caletti G. C., Brocchi E., Ferrari A., Fiorino S., Barbara L. Value of endoscopic ultrasonography in the management of portal hypertension. Endoscopy. 1992 May;24 (Suppl 1):342–346. doi: 10.1055/s-2007-1010496. [DOI] [PubMed] [Google Scholar]
  4. Caletti G., Brocchi E., Baraldini M., Ferrari A., Gibilaro M., Barbara L. Assessment of portal hypertension by endoscopic ultrasonography. Gastrointest Endosc. 1990 Mar-Apr;36(2 Suppl):S21–S27. doi: 10.1016/s0016-5107(90)71011-5. [DOI] [PubMed] [Google Scholar]
  5. Clark K. E., Foley W. D., Lawson T. L., Berland L. L., Maddison F. E. CT evaluation of esophageal and upper abdominal varices. J Comput Assist Tomogr. 1980 Aug;4(4):510–515. doi: 10.1097/00004728-198008000-00020. [DOI] [PubMed] [Google Scholar]
  6. Conn H. O. Ammonia tolerance in the diagnosis of esophageal varices. A comparison of endoscopic, radiologic, and biochemical techniques. J Lab Clin Med. 1967 Sep;70(3):442–451. [PubMed] [Google Scholar]
  7. DOEHNER G. A., RUZICKA F. F., Jr, ROUSSELOT L. M., HOFFMAN G. The portal venous system: on its pathological roentgen anatomy. Radiology. 1956 Feb;66(2):206–217. doi: 10.1148/66.2.206. [DOI] [PubMed] [Google Scholar]
  8. Dilawari J. B., Raju G. S., Chawla Y. K. Development of large spleno-adreno-renal shunt after endoscopic sclerotherapy. Gastroenterology. 1989 Aug;97(2):421–426. doi: 10.1016/0016-5085(89)90078-4. [DOI] [PubMed] [Google Scholar]
  9. Hashizume M., Kitano S., Sugimachi K., Sueishi K. Three-dimensional view of the vascular structure of the lower esophagus in clinical portal hypertension. Hepatology. 1988 Nov-Dec;8(6):1482–1487. doi: 10.1002/hep.1840080603. [DOI] [PubMed] [Google Scholar]
  10. Hedberg S. E., Fowler D. L., Ryan R. L. Injection sclerotherapy of esophageal varices using ethanolamine oleate. Am J Surg. 1982 Apr;143(4):426–431. doi: 10.1016/0002-9610(82)90191-x. [DOI] [PubMed] [Google Scholar]
  11. Hoevels J., Lunderquist A., Tylén U., Simert G. Porto-systemic collaterals in cirrhosis of the liver. Selective percutaneous transhepatic catheterization of the portal venous system in portal hypertension. Acta Radiol Diagn (Stockh) 1979;20(6):865–877. doi: 10.1177/028418517902000602. [DOI] [PubMed] [Google Scholar]
  12. Kimmey M. B., Martin R. W., Haggitt R. C., Wang K. Y., Franklin D. W., Silverstein F. E. Histologic correlates of gastrointestinal ultrasound images. Gastroenterology. 1989 Feb;96(2 Pt 1):433–441. doi: 10.1016/0016-5085(89)91568-0. [DOI] [PubMed] [Google Scholar]
  13. Kitano S., Terblanche J., Kahn D., Bornman P. C. Venous anatomy of the lower oesophagus in portal hypertension: practical implications. Br J Surg. 1986 Jul;73(7):525–531. doi: 10.1002/bjs.1800730704. [DOI] [PubMed] [Google Scholar]
  14. Korula J., Balart L. A., Radvan G., Zweiban B. E., Larson A. W., Kao H. W., Yamada S. A prospective, randomized controlled trial of chronic esophageal variceal sclerotherapy. Hepatology. 1985 Jul-Aug;5(4):584–589. doi: 10.1002/hep.1840050410. [DOI] [PubMed] [Google Scholar]
  15. Lin C. Y., Lin P. W., Tsai H. M., Lin X. Z., Chang T. T., Shin J. S. Influence of paraesophageal venous collaterals on efficacy of endoscopic sclerotherapy for esophageal varices. Hepatology. 1994 Mar;19(3):602–608. doi: 10.1002/hep.1840190310. [DOI] [PubMed] [Google Scholar]
  16. Lo G. H., Lin C. Y., Lai K. H., Malik U., Ng W. W., Lee F. Y., Lee S. D., Tsai Y. T., Lo K. J. Endoscopic injection sclerotherapy versus conservative treatment for patients with unresectable hepatocellular carcinoma and bleeding esophageal varices. Gastrointest Endosc. 1991 Mar-Apr;37(2):161–164. doi: 10.1016/s0016-5107(91)70677-9. [DOI] [PubMed] [Google Scholar]
  17. McCormack T. T., Rose J. D., Smith P. M., Johnson A. G. Perforating veins and blood flow in oesophageal varices. Lancet. 1983 Dec 24;2(8365-66):1442–1444. doi: 10.1016/s0140-6736(83)90796-1. [DOI] [PubMed] [Google Scholar]
  18. Rose J. D., Crane M. D., Smith P. M. Factors affecting successful endoscopic sclerotherapy for oesophageal varices. Gut. 1983 Oct;24(10):946–949. doi: 10.1136/gut.24.10.946. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Rösch T. Endoscopic ultrasonography. Endoscopy. 1992 Jan-Feb;24(1-2):144–153. doi: 10.1055/s-2007-1010453. [DOI] [PubMed] [Google Scholar]
  20. Söderlund C., Backman L., Erwald R., Forsgren L., Marions O., Wiechel K. L. Sclerotherapy of esophageal varices: an endoscopic and portographic study. Hepatology. 1984 Sep-Oct;4(5):877–884. doi: 10.1002/hep.1840040514. [DOI] [PubMed] [Google Scholar]
  21. Takase Y., Shibuya S., Chikamori F., Orii K., Iwasaki Y. Recurrence factors studied by percutaneous transhepatic portography before and after endoscopic sclerotherapy for esophageal varices. Hepatology. 1990 Mar;11(3):348–352. doi: 10.1002/hep.1840110303. [DOI] [PubMed] [Google Scholar]

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