Evaluation and management of esophageal varices by through‐the‐scope endoscopic Doppler probe method

Abstract

Objectives: Objective assessments of esophageal varices (EVs) are inadequate. The recurrence of variceal bleeding after endoscopic variceal ligation (EVL) is associated with residual blood flow underlying EVL or incomplete treatment of a perforating vein by EVL. We aimed to assess our novel through-the-scope endoscopic Doppler probe method (DOP) for the evaluation and management of EVs.Methods: This study included 20 patients (54 varices) with a history of esophageal variceal rupture from June 2019 to May 2021 who underwent DOP at a tertiary hospital. Variceal velocities were compared based on the size and endoscopic variceal findings. Additionally, we performed EVL assisted by DOP (EVL + DOP) in nine patients.Results: Doppler imaging of EVs was observed in all 20 patients. The velocity of varices was significantly higher in EVs with a larger size, greater form, blue color, and red color sign positive. Perforating veins connecting to the EVs were identified in six out of nine patients who underwent EVL + DOP. Eight out of nine patients underwent repeat EVL. Repeat EVL was performed until the variceal velocity reached absent. No recurrence of variceal bleeding occurred during the follow-up period (mean 8.7 AE 3.2 months). No adverse events associated with DOP were observed. Conclusion:The evaluation of EVs using DOP is feasible and accurate. EV velocities are related to the variceal size, form, blue color, and red color sign. EVL + DOP may be a more reliable treatment for EVs. Further large-scale, long-term comparative studies are warranted.

A Noninvasive Technology Using Artificial Intelligence to Measure the Diameter of Esophageal Varices Under Endoscopy

“…Visual observation is considered to be the most common method for estimating the diameter of EVs, although the results of EV diameter measurement can vary greatly between endoscopists. Several previous studies have attempted to measure variceal size 6,7. The esophageal varix manometer (EVM) is one of the tools that is used to measure the diameter of EVs.…”

“…Several previous studies have attempted to measure variceal size. 6,7 The esophageal varix manometer (EVM) is one of the tools that is used to measure the diameter of EVs. It was first used by Scheurlen et al, 2 who aimed to compare the association between the diameter with the pressure in EVs.…”

Through‐the‐scope endoscopic Doppler probe method before endoscopic variceal ligation

“…On the other hand, convex type CDEUS puts a lot of burden on patients, as mentioned above. In such a dilemma, Shiratori et al 9 reported the usefulness of the through-the-scope Doppler method for EVs dynamic flow evaluation before EVL. They used the novel Doppler system that can evaluate the direction and velocity of EVs.…”

“…Although detailed data are not shown, Shiratori et al 9 applied the through-the-scope Doppler method to gastric varices and revealed that the velocities of gastric varices are larger than those of EVs. For this reason, they assumed that gastric varices are relatively near the liver, where the blood flow is large and split into several collateral EVs.…”

“…Although detailed data are not shown, Shiratori et al 9 . applied the through‐the‐scope Doppler method to gastric varices and revealed that the velocities of gastric varices are larger than those of EVs.…”