A comparative study of esophageal varices by endoscopy and percutaneous transhepatic esophageal phlebography

Abstract

Twenty patients with portal hypertension due to cirrhosis were examined by esophagoscopy and percutaneous transhepatic esophageal phlebography. Esophageal varices were found in 18 cases at endoscopy and in 19 cases at esophageal phlebography. There was little correlation between the findings of the two methods with respect to the size and number of esophageal varices. At endoscopy the subepithelial and submucosal varices were reliably detected. At esophageal phlebography differentiation between intrinsic (i.e. subepithelial and submucosal veins) and peri-esophageal veins was not possible. Negative findings at esophageal phlebography do not rule out esophageal varices.

Gastric metastasis of hepatocellular carcinoma via a possible existing retrograde hematogenous pathway

“…With the increase of intrahepatic vascular resistance in liver cirrhosis, portal hypertension developed and a retrograde flow was established from the portal system into the left gastric and splenic veins. The left gastric vein flowing into the gastric wall is divided into thin parallel veins around the cardia or ‘sudare veins’ in the lower esophagus 14–17 . When HCC invaded the portal vein with intravariceal tumor thrombi, the main variceal vein was seldom occluded completely.…”

Role of para‐esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis

“…Many kinds of collaterals develop in patients with portal hypertension for reduction of high portal pressure 1–7 . In terms of the direction of blood flow, these collaterals can be divided into two groups: (i) descending collaterals from portal veins such as gastro‐renal or spleno‐renal shunts; 12,22 and (ii) ascending collaterals from portal veins such as esophageal varices or para‐ECV 1–13,23 .…”

“…Many kinds of collaterals develop in patients with portal hypertension for reduction of high portal pressure 1–7 . In terms of the direction of blood flow, these collaterals can be divided into two groups: (i) descending collaterals from portal veins such as gastro‐renal or spleno‐renal shunts; 12,22 and (ii) ascending collaterals from portal veins such as esophageal varices or para‐ECV 1–13,23 . While previous studies have demonstrated that gastro‐renal or spleno‐renal shunts (descending collaterals from portal vein) influence the prevention of variceal recurrence (endoscopic and hemorrhagic recurrence) after treatment for esophago‐gastric varices, 7,12 , 21 these major porto‐systemic shunts exist in less than 20% of patients with esophageal varices who have no associated fundal gastric varices 7 .…”

Modified devascularization surgery for isolated gastric varices assessed by endoscopic ultrasonography

“…In recent years, percutaneous transhepatic portography (PTP) and splenic venography has been the gold standard for the study of portal collateral circulation in patients with cirrhosis and IGV [8]. However, it is difficult to distinguish between intrinsic intramural veins and extraluminal collaterals using PTP [8].…”

“…However, it is difficult to distinguish between intrinsic intramural veins and extraluminal collaterals using PTP [8]. Moreover, the invasiveness of this procedure and the requirement of skillful technique further limit its use in clinical practice.…”