Analysis of extramural collaterals by endoscopic ultrasonography before and after treatment of esophageal varices

Background and Aims: Endoscopic variceal ligation (EVL) has been widely employed in recent years because of the safety and simplicity, but the high recurrence rate relatively early after the therapy compaired with endoscopic injection sclerotherapy (EIS) is problematic. Therefore, in the present study, are investigated the hemodynamic changes of esophagogastric varices before and after these treatments using endoscopic ultrasonography (EUS). One advantage of EUS is that it can distinguish the blood vessels within the wall of the digestive tract from those locating outside the wall. In this study, we compared the post-treatment changes of varicose extramural collaterals between EVL and EIS, paying special attention to the extragastric veins (EGV) at the lesser curvature of the cardiac region which receives direct inflow from the blood supplying route for varices and paraesophageal veins (PEV). Subjects and Methods : Twenty three patients with esophageal varices treated by EVL (EVL group) and another 23 treated by EIS (EIS group) from August 1992 to April 1998 were studied. In these patients, esophagogastric hemodynamics was investigated by EUS before and after the treatments. EGV and PEV were evaluated by measuring the diameters and the total transverse areas on EUS images. Results: The change of PEV before and after the treatments was small, and was not significantly different between the EVL and EIS groups. In the EVL group, both the mean diameter and the mean total transverse area of EGV did not show significant changes before and after the treatment, whereas the mean diameter of EGV of the EIS group was significantly decreased after the treatment (from 4.71±2.19 mm to 2.90±2.01 mm; p<0.0001), and the mean total transverse area of EGV of the EIS group was also significantly decreased after the treatment (from 1.16±1.17 cm ² to 0.44±0.65 cm ²; p<0.0001). The rate of changes in the PEV was not significantly different between the EVL group and EIS group, whereas that of EGV was significantly greater in the EIS group than in the EVL group (p<0.0001). Conclusions : This study clarified the difference in the esophagogastric hemodynamics after EVL and EIS; EIS could close the blood-supplying route for varices effectively and reduced the blood flow of collaterals (EGV), whereas EVL did not have significant effects on the extramural collaterals including EGV. This may be a reason why the recurrence occurs shortly after EVL but it does not occur relatively long after EIS.