4527 The role of para-esophageal collateral veins in patients with portal hypertension: eus and liver scintigraphy analysis.

Abstract

Background: In patients with portal hypertension, many collaterals develop around the esophageal wall. Endoscopic ultrasonography (EUS) can reveal the para-esophageal collateral veins (para-ECVs) around the esophageal wall (Gastrointestinal Endosc 1999;50). Liver scintigraphy using 99mTc-phytate enables quantitative grading of the ratio of portal venous to total hepatic blood flow. Collaterals that have developed around the esophageal wall are thought to cause a reduction in the portal blood flow ratio (PBFR). To verify the role of para-ECVs on portal venous blood flow, we investigated the relationship between the development of para- ECVs and the PBRF by EUS and liver scintigraphy. Patients and Method: Twenty patients who did not associate with fundal gastric varices were studied before and after endoscopic injection screlotherapy (EIS). To quantify the degree of development of blood vessels outside the esophageal wall, the cross-sectional area of each para-ECVs observed by EUS was calculated, and the sum total of the areas was used as an index of development of para-ECVs. Portal blood flow was calculated by liver scintigraphy using 99mTc-phytate. Results: The correlation between PBRF and the total cross sectional area of the para-ECVs before and after treatment was examined. Before EIS, the PBRF was 53.42±12.34 % (mean±SD), and the total crosssectional area of the para-ECVs was 34.15±22.39 mm2 (mean±SD). The correlation between the PBRF and the total cross sectional area of para- ECVs before EIS was not significant. On the other hand, the PBFR was 53.42±12.34 % (mean±SD) and the total cross-sectional area of the para- ECVs was 34.15±22.39 mm2 (mean±SD) after EIS. After treatment, the correlation between these two parameters was significant (r=0.70, p<0.01). Conclusion: Portal venous flow is related to the development of para-ECVs after EIS. Para-ECVs reduce the portal venous pressure after EIS in patients with esophageal varices. Background: In patients with portal hypertension, many collaterals develop around the esophageal wall. Endoscopic ultrasonography (EUS) can reveal the para-esophageal collateral veins (para-ECVs) around the esophageal wall (Gastrointestinal Endosc 1999;50). Liver scintigraphy using 99mTc-phytate enables quantitative grading of the ratio of portal venous to total hepatic blood flow. Collaterals that have developed around the esophageal wall are thought to cause a reduction in the portal blood flow ratio (PBFR). To verify the role of para-ECVs on portal venous blood flow, we investigated the relationship between the development of para- ECVs and the PBRF by EUS and liver scintigraphy. Patients and Method: Twenty patients who did not associate with fundal gastric varices were studied before and after endoscopic injection screlotherapy (EIS). To quantify the degree of development of blood vessels outside the esophageal wall, the cross-sectional area of each para-ECVs observed by EUS was calculated, and the sum total of the areas was used as an index of development of para-ECVs. Portal blood flow was calculated by liver scintigraphy using 99mTc-phytate. Results: The correlation between PBRF and the total cross sectional area of the para-ECVs before and after treatment was examined. Before EIS, the PBRF was 53.42±12.34 % (mean±SD), and the total crosssectional area of the para-ECVs was 34.15±22.39 mm2 (mean±SD). The correlation between the PBRF and the total cross sectional area of para- ECVs before EIS was not significant. On the other hand, the PBFR was 53.42±12.34 % (mean±SD) and the total cross-sectional area of the para- ECVs was 34.15±22.39 mm2 (mean±SD) after EIS. After treatment, the correlation between these two parameters was significant (r=0.70, p<0.01). Conclusion: Portal venous flow is related to the development of para-ECVs after EIS. Para-ECVs reduce the portal venous pressure after EIS in patients with esophageal varices.