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

Abstract

In patients with severe liver cirrhosis (LC), it is very important to decrease the recurrence rate of esophageal varices (EVs) and maintain their liver function, because liver transplantation is limited in Japan compared with Western countries. Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are standard methods for the treatment of EVs. The recurrence rate after EIS is known to be much lower than that after EVL. 1 The EVs recurrence rate after EVL is related to the remaining varices in the submucosal or muscular layer with the perforating veins (PEV). 2 Therefore, a detailed understanding of the hemodynamics by endoscopic ultrasound (EUS) is important, especially for EVL. Liao et al. 3 reported that volumetric changes in para-esophageal collateral veins (para-ECVs) after treatment are the predictors of EVs recurrence. Irisawa et al. 4 reported that peri-esophageal collateral veins (peri-ECVs), which developed as the small vessels around EVs, and PEV after treatment were associated with the development and recurrence of EVs. In that report, the diameter of the peri-ECVs at 10 months after EIS was larger in the EVs recurrence group than that in the nonrecurrence group. 4 Kume et al. 5 also reported that the state without PEV was the long-term nonrecurrence predictor after EVL. These reports were shown by intraductal ultrasonography (IDUS) using a miniature probe. Unlike this, Kuramochi et al. calculated the velocity of collateral veins using color Doppler EUS (CDEUS) and reported that the posterior branch of the left gastric vein (LGV) developed as para-ECVs and that the anterior branch directly fed EVs. They also revealed that peri-ECVs and PEV were the recurrence factors of EVs. 6 Based on these reports, EIS is thought to adapt to the cases with advanced peri-ECVs or PEV, and EVL adapts to the cases with advanced para-ECVs. Hino et al. 7 showed that the LGV velocity (calculated by CDEUS) was lower in the nonrecurrence group after EVs treatment than in the recurrence group (9.9 vs. 13.9 cm/s; P = 0.02). As mentioned above, CDEUS is a useful technique to grasp EVs in detail, but this method is unsuitable for routine clinical examination because the