3557 Usefulness of infrared ray electronic endoscopy for evaluating the effects of endoscopic therapy on esophageal varices.

Abstract

Objective: Previous studies have demonstrated that an infrared ray electronic endoscope (IRE) is useful for evaluating the effects of endoscopic therapy on esophageal varices(EV) and the presence or absence of varices remaining in blood flow after treatment. In this study, we assessed the usefulness of IRE in patients undergoing endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL).Subjects and Methods: The subjects consisted of 30 patients with EV who underwent EIS or EVL. One month after the end of EIS and EVL, the lesions were examined under infrared ray (IR) using GIF-Q200IR (Olympus Co.) during rapid intravenous injection of ICG (2 mg/kg), and endoscopic findings were examined. Endoscopic findings were classified into "a heterogeneous densely stained zone (DS) in which part of the lesion was heterogeneously and densely stained after intravenous injection of ICG'',"a highly densely stained microvessel image (HDS) on which 50% or more of the microvessels recognized under visible ray (VR) was densely stained after intravenous injection of ICG'' and "a less densely stained microvessel image (LDS) on which fewer than 50% of the microvessels were densely stained''. Patients whose conditions were followed were examined using endoscopy under VR for the presence or absence of recurrence. Moreover, X=(pixel value of vessels recognized under VR) / (pixel value of the area densely stained under IR after intravenous injection of ICG) yen 100 was determined using an image processor and compared between patients with recurrence and those without recurrence. Results: 1. Under IR, HDS was noted in 13 patients, LDS in 15 patients, DS in 7 patients, and there was no area densely stained in 3 patients. 2. During a mean follow-up of 12 months, recurrence was observed in 8 of 23 patients, including 7 of 9 patients showing HDS under IR and one of 8 patients demonstrating LDS, but there was no recurrence in patients not showing any densely stained area. 3. Of patients whose conditions were followed using image analysis, the mean X value was 4.2% in patients without recurrence and 173.7% in patients with recurrence, showing a significantly higher value in the latter group (p < 0.05). Conclusion: 1. In combination with intravenous injection of ICG, IRE proved to be useful for examining varices remaining in blood of the esophagus after EIS and EVL. 2. As a finding to predict recurrence, a densely stained microvessel image is considered important and its extent can be a factor in predicting recurrence.