3560 Evaluation of solitary and scattered esophageal varices by infrared-ray endoscopy and endoscopic ultrasonography.

Abstract

Objective: Solitary esophageal varices (SoV) sporadically develop in the upper and middle esophagus, while scattered esophageal varices (ScV) consist of more than two variceal lesions. It is considered that both SoV and ScV differ from portal hypertensive esophageal varices or so-called down hill varices. However, the etiology and clinical significance of SoV and ScV remain unclear. In the present study, using both IRE and EUS, we evaluated the internal characteristics and hemodynamics of SoV and ScV. Subjects and Methods: The subjects consisted of 44 lesions in 28 patients in whom SoV or ScV were detected by visible ray endoscopy (VRE). These lesions were evaluated by IRE and EUS. During IRE, the intensity of blueblack color was evaluated using GIF-Q200IR (Olympus Co., Ltd.). Subsequently, 2 mg/kg of ICG was rapidly injected intravenously to evaluate the degree of stainability by three stages. During EUS, the major location and echo patterns of SoV and ScV were observed using an ultrasonic miniprobe. Echo patterns were classified as follows: homogeneous low echo, mixed echoes, and homogeneous high echo. Results: When the relationship between the size of SoV or ScV and the degree of stainability during IRE was evaluated in densely stained lesions, the diameter of SoV or ScV was significantly smaller in lesions that showed stronger stainability than in those that showed weaker stainability. When the relationship between the size of SoV or ScV and echo patterns observed by EUS was evaluated, the diameter was significantly smaller in lesions that showed homogeneous low echo than in those that showed mixed echoes. When the relationship between echo patterns observed by EUS and the degree of stainability during IRE was evaluated, lesions that showed homogeneous high echo showed the weakest stainability, followed by lesions that showed mixed echoes and those that showed homogeneous low echo in ascending order. Conclusion: Concomitant i.v. injection of ICG was useful for observing hemodynamics of SoV and ScV during IRE, as well as observing the major location or morphology of these variceal lesions during EUS. SoV and ScV with larger diameters were stained later when hemodynamics were evaluated by IRE, and showed a mixture of low and high echo areas when the morphology was evaluated by EUS. These observations suggested that internal blood flow of SoV or ScV was arrested, and the severity of extravasation of blood increased with the diameter of variceal lesions.