Value of Endoscopic Ultrasonography in the Management of Portal Hypertension

Caletti, G.; Brocchi, Emilio; Ferrari, Ângelo Paulo; Fiorino, Sirio; Barbara, L

doi:10.1055/s-2007-1010496

Cited by 88 publications

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“…PSCV present in the periesophageal, peri-gastric and perirectal areas are easily seen by EUS. [14][15][16][17][18] Veins on the mucosal aspect can cause gastrointestinal luminal bleeding and those outside the wall may cause extraluminal i.e. pleural or peritoneal bleeding.…”

Section: Order Of Appearance Of Collateralmentioning

confidence: 99%

“…Sato et al demonstrated that intramural rectal varices, perirectal collateral veins, and the communicating veins between intramural rectal varices and perirectal collateral veins could be observed clearly via an ultrasonic microprobe. 15,[59][60][61][62] The right colon is drained by three tributaries of SMV, which include the ileocolic, right colic and middle colic veins. Tributaries joining inferior mesenteric vein drain the rest of the colon.…”

Section: Applied Anatomy Of Colonic and Rectal Varicesmentioning

confidence: 99%

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Collateral Pathways in Portal Hypertension

Sharma

Rameshbabu²

2012

Journal of Clinical and Experimental Hepatology

128

104

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Presence of portosystemic collateral veins (PSCV) is common in portal hypertension due to cirrhosis. Physiologically, normal portosystemic anastomoses exist which exhibit hepatofugal flow. With the development of portal hypertension, transmission of backpressure leads to increased flow in these patent normal portosystemic anastomoses. In extrahepatic portal vein obstruction collateral circulation develops in a hepatopetal direction and portoportal pathways are frequently found. The objective of this review is to illustrate the various PSCV and portoportal collateral vein pathways pertinent to portal hypertension in liver cirrhosis and EHPVO. ( J CLIN EXP HEPATOL 2012;2:338-352) A lmost any vein in the abdomen may serve as a potential collateral channel to the systemic circulation. Presence of abnormal collateral vessels appears to be one of the most sensitive (70-83%) and specific sonographic signs for the diagnosis of portal hypertension. 1 When blood flow through a vessel or a vascular bed is obstructed due to occlusion, as in EHPVO, or distortion, as in liver cirrhosis, collateral pathways open up as blood bypasses the occlusion or obstruction, always flowing down a pressure gradient from a high pressure to a low-pressure vessel or bed. The formation of portosystemic pathways occurs due to reopening of collapsed embryonic channels or reversal of the flow within existing adult veins. 2,3 The number of collateral channels depends on the severity of portal hypertension i.e. the differential gradient driving the flow between the portal and the systemic circulations and the duration of portal hypertension. The more severe and more prolonged the portal hypertension, the higher are the number of portosystemic pathways. However, this traditional hypothesis has been challenged and it has been suggested that the formation of portosystemic collateral circulation may be due in part to angiogenesis driven by vascular endothelial growth factor. 4,5 Almost 50 years have passed since the first detailed description of portosystemic collateral veins (PSCV) in portal hypertension appeared. 6 Precise mapping of PSCV is essential to therapeutic decisions and multidetector computerized tomography (MDCT) is sometimes used for cartography of PSCV. 7 EUS is increasingly being used for evaluation of PSCV and additionally provides an option for performing therapeutic interventions. 8 In addition to PSCV, PPCV pathways are frequently found in extrahepatic portal vein obstruction (EHPVO). The objective of this review is to illustrate the various PSCV and PPCV pathways pertinent to portal hypertension in liver cirrhosis and EHPVO. NORMAL PORTOSYSTEMIC ANASTOMOSESThe left gastric vein (LGV) anastomoses with the esophageal veins, which in turn drain into the azygos vein (AV). The superior rectal vein (SRV) anastomoses with the middle and inferior rectal veins (IRV), which are, respectively, tributaries of the internal iliac and the pudendal veins. The paraumbilical vein (PUV) anastomoses with subcutaneous veins in the anterior abdominal...

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Section: Order Of Appearance Of Collateralmentioning

confidence: 99%

Section: Applied Anatomy Of Colonic and Rectal Varicesmentioning

confidence: 99%

Collateral Pathways in Portal Hypertension

Sharma

Rameshbabu²

2012

Journal of Clinical and Experimental Hepatology

128

104

View full text Add to dashboard Cite

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“…Endoscopic Ultrasonography (EUS) is a useful modality for the diagnosis for esophagogastric varices [6][7]. With the provision of Doppler capabilities, ECDUS allows the sonographic visualization of the vessels, as well as evaluation of vascular blood flow and morphology [8][9].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

GOA

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A 71-year-old woman was admitted to our hospital for treatment of cancer in the body and tail of the pancreas. After admission, she had tarry stool and esophagogastroduodenoscopy (EGD) was performed. EGD revealed enlarged tortuous, red color sign negative gastric varices between the cardiac orifice, fundus and the curvature ventriculi major of the gastric body.Computed tomography showed gastric varices due to splenic vein occlusion with advanced pancreatic cancer (left-sided portal hypertension).However, endoscopic observation was not sufficient to identify the bleeding site of the gastric varices.Consecutively, endoscopic color Doppler ultrasonography (ECDUS) was performed to evaluate the gastric varices in detail.ECDUS showed the velocity of gastric varices in the cardiac orifice and fundus to be 11.7 cm/sec, the thickness of the gastric wall to the submucosal gastric varices being 1.0 mm, and the gastric varices in the cardiac orifice and fundus were diagnosed as the likely bleeding site. Subsequently, we performed endoscopic obliterative therapy with 70% n-butyl-2-cyanoacrylate diluted with 5% Lipiodol at the possible bleeding site of these varices. The patient experienced no further episodes of bleeding during the three months following treatment.

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“…Endoscopic ultrasonography (EUS) has become a useful modality for the diagnosis for esophagogastric varices, and it is considered most useful in evaluating gastric varices [27][28][29]. In a previous report, Sato et al described the utility of endoscopic color Doppler ultrasonography (ECDUS) in patients with gastric varices [30].…”

Section: Diagnosis Of Gastric Varices Secondary To Left-sided Portal mentioning

confidence: 99%

Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

Kimura¹

2013

Pancreat Disord Ther

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Sato et al., Pancreatic Dis Ther 2013, S3 http://dx.doi.org/10.4172/2165 Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases Takahiro Sato*, Sho Kitagawa, Mutsuumi Kimura, Takumi Ohmura, Yoshiyasu Karino and Jouji Toyota Department of Gastroenterology, Sapporo Kosei General Hospital, Japan occlusion because of the splenic vein, s anatomy. Sutton et al. reported that 35% of their cases of isolated splenic vein occlusion were caused by tumors and only 17% by pancreatitis [9]. On the other hand, Sakorafas et al. found that pancreatitis was the etiology in 87 (60%) of 144 cases, while pancreatic malignancy was detected in only [13] (9%) of the patients [7], and recent reviews have clarified acute or chronic pancreatitis to be the probable cause of splenic vein thrombosis in the majority of cases [18]. There is a possible pathogenetic mechanism implying the increased intra-abdominal pressure leading to compression of the splenic vein in the case of pancreatic pseudocyst [19,20].Due to splenic vein occlusion, splenic venous flow must drain into collateral veins (short gastric vein and left gastroepiploic vein). Then, the increased blood flow dilates the submucosal veins of stomach, resulting in gastric varices (Figure 1). Because blood drainage is diverted by the coronary vein into the patent portal system, the presence of gastric varices without esophageal varices is a very specific sign of splenic vein occlusion [17]. This condition, which is commonly silent clinically, can cause hypersplenism or gastrointestinal hemorrhage.Although splenic vein occlusion is commonly silent clinically, AbstractGastric varices that arise secondary to splenic vein occlusion can result in hypersplenism or gastrointestinal hemorrhaging. This article review gastric varices secondary to splenic vein occlusion due to pancreatic diseases with regard to causes of the condition, as well as diagnostic and therapeutic approaches.Diagnosis of gastric varices is made following esophago-gastro-duodenoscopy, and splenic vein occlusions are diagnosed from enhanced computed tomographic scans in almost all cases. Specific findings of gastric varices secondary to splenic vein occlusion are based on endoscopic ultrasonographic color flow images of gastric variceal flow that clearly depicted round cardiac and fundal regions at the center, with varices expanding to the curvatura ventriculi major of the gastric body.Several treatment options for gastric variceal bleeding secondary to splenic vein occlusion have been proposed. Splenectomy, which decompresses the short gastric vein by cutting off inflow, has generally been considered the best treatment of choice in such condition. Endoscopic injection sclerotherapy using cyanoacrylate, is useful in the treatment of bleeding gastric varices due to splenic vein occlusion. As patients with splenic vein occlusion have normal portal pressure and normal hepatic function, portal systemic shunting is not indicated. Splenic arterial embolization, which reduces blood flow through the sp...

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Value of Endoscopic Ultrasonography in the Management of Portal Hypertension

Cited by 88 publications

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Collateral Pathways in Portal Hypertension

Collateral Pathways in Portal Hypertension

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Gastric Varices Secondary to Splenic Vein Occlusion due to Pancreatic Diseases

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