Endoscopic ultrasonographic evaluation of hemodynamics related to variceal relapse in esophageal variceal patients

Sato, Takahiro; Yamazaki, Katsu; Toyota, Jouji; Karino, Yoshiyasu; Ohmura, Takumi; Akaike, Jun

doi:10.1111/j.1872-034x.2008.00415.x

Cited by 32 publications

(29 citation statements)

References 19 publications

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“…Residual veins in the esophagus wall have been reported to be associated with a high risk of the reoccurrence of varices. [5] Based on this, we recommend EUS after EVL; however, the patient in the present case refused. In consideration of the high risk of recurrence, he underwent endoscopy 6 months later, and the recurrence of esophageal varices was observed.…”

Section: Discussionmentioning

confidence: 88%

Endoscopic ultrasonography predicts early esophageal variceal bleeding in liver cirrhosis

Men

Zhang²

2017

Medicine

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Rationale:Bleeding esophageal and gastric varices constitute a serious complication in liver cirrhosis. Previous studies have shown that endoscopic ultrasonography (EUS) can be used to predict early esophageal variceal bleeding in liver cirrhosis.Patient concerns:We report a case of a 46-year-old man with hepatitis B liver cirrhosis (CTP score, 5; Child–Pugh class, A) who was admitted to our hospital due to a decreased appetite lasting 1 week.Diagnosis:He was initially diagnosed with decompensated hepatitis B cirrhosis; an abdominal computed tomography (CT) scan indicated a diagnosis of liver cirrhosis and portal hypertension (PHT).Interventions:Common endoscopic examination showed no evidence of gastroesophageal varices; EUS revealed distinct varices of the esophageal and gastric veins. Six months after discharge, the patient was rehospitalized because of upper gastrointestinal bleeding. Endoscopic ligation was implemented as well as esophageal varices loop ligature (EVL).Outcomes:Six months later, EUS showed obvious collateral and perforator veins.Lessons:We should strongly recommend that patients with liver cirrhosis undergo EUS in addition to a routine endoscopic examination. EUS can play an important role in evaluating the risk for bleeding in PHT and can be used to assess the efficacy of EVL.

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Section: Discussionmentioning

confidence: 88%

Endoscopic ultrasonography predicts early esophageal variceal bleeding in liver cirrhosis

Men

Zhang²

2017

Medicine

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“…Thus, identification of patients with large “deep” varices is of clinical importance. Also, an advanced hemodynamic study utilizing endoscopic color Doppler ultrasonography showed its potential usefulness in predicting recurrent variceal bleeding [17]. …”

Section: Discussionmentioning

confidence: 99%

Correlation between Endosonographic and Doppler Ultrasound Features of Portal Hypertension in Patients with Cirrhosis

Wiechowska–Kozłowska

Zasada²,

Milkiewicz

et al. 2012

Gastroenterology Research and Practice

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Purpose. Endoscopic ultrasound (EUS) permits the detailed visualization of clinically significant features of portal hypertension; however, it is an invasive procedure that is not widely available. The aim of this cross-sectional study was to determine whether a correlation exists between the features of portal hypertension detected using both Doppler ultrasound and EUS in subjects with liver cirrhosis. Materials and Methods. Analyzed cohort included 42 patients who underwent a detailed Doppler ultrasound focusing on the parameters of blood flow in the portal/splenic vein as well as an endoscopic/EUS procedure that included the assessment of the size and localization of “deep” varices. Results. The size of “deep” oesophageal varices detected with EUS exhibited no correlation with the parameters assessed by Doppler ultrasound. However, the size of the “deep” gastric varices detected using EUS correlated with the time averaged maximum velocity (Tmax as well as Vmin, Vmax) for the portal vein using Doppler ultrasound and exhibited a correlation with the Vmax and Tmax for the splenic vein. No significant correlation was determined between the diameter of the azygous vein and the thickness of the gastric wall when seen on EUS versus the parameters measured with Doppler ultrasound. Conclusion. EUS provides important information regarding the features of portal hypertension, and in the case of “deep” oesophageal varices exhibits a limited correlation with the parameters detected by Doppler ultrasound. Thus, despite its invasiveness, EUS is a method that provides a reliable and unique assessment of the features of portal hypertension in patients with liver cirrhosis.

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“…The size of such peri-esophageal veins appears to correlate with bleeding risk [2]. Several studies have also confirmed that the ongoing presence of these veins after endoscopic treatment is associated with an increased risk of recurrence [3,4]. …”

Section: Esophageal Varicesmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Vascular Therapy: The Present and the Future

et al. 2017

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Endoscopic ultrasound (EUS) offers access to many intra-abdominal vessels that until now have only been accessible to the surgeon and interventional radiologist. In addition to assisting with diagnostics, this unique access offers the potential for therapeutic intervention for a host of indications. To date, this has had the most clinical impact in the treatment of gastroesophageal varices, with EUS-guided coil and glue application growing in use worldwide. Although randomised controlled trial data is lacking, we discuss the growing body of literature behind EUS-guided therapy in the management of varices. EUS has also been used in specialized centres to assist in non-variceal gastrointestinal bleeding. The treatment of bleeding from Dieulafoy lesions, tumours and pancreatic pseudoaneurysms has all been described. The potential applications of EUS have also extended to the placement of portal vein stents and porto-systemic shunts in animal models. As medicine continues to move to increasingly less invasive interventions, EUS-guided therapies offer substantial promise for the safe and effective delivery of targeted treatment for a widening array of vascular disorders.

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Endoscopic ultrasonographic evaluation of hemodynamics related to variceal relapse in esophageal variceal patients

Abstract: Endoscopic ultrasonographic evaluation of the hemodynamics in esophageal varices before and after EIS enables prediction of early variceal recurrence.

Cited by 32 publications

References 19 publications

Endoscopic ultrasonography predicts early esophageal variceal bleeding in liver cirrhosis

Endoscopic ultrasonography predicts early esophageal variceal bleeding in liver cirrhosis

Correlation between Endosonographic and Doppler Ultrasound Features of Portal Hypertension in Patients with Cirrhosis

Endoscopic Ultrasound-Guided Vascular Therapy: The Present and the Future

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