Abstract
Endoscopic Feature of Gastric Varices Caused by Left-Sided Portal Hypertension due to Pancreatic Disease Tadayuki J. Takagi, Atsushi Irisawa, Katsutoshi Obara, Ayako Saito, Goro Shibukawa, Go Yamamoto, Takuto Hikichi, Takeru Wakatsuki, Hidemichi Imamura, Yukio Sato Background: Left-sided portal hypertension was occurred by the stricture of splenic vein due to the infiltration of the pancreatic inflammation or carcinoma, and then gastric varices often developed. The aim of this study is to reveal the endoscopic feature of gastric varices caused by left-sided portal hypertension due to pancreatic disease. Patients and Methods: One hundred six patients with pancreatic disease (chronic pancreatitis;45, carcinoma;60, metastasis;2) who were undergone endoscopic examination in our hospital were enrolled. The pancreatic diseases were diagnosed by computed tomography, ultrasonography, ERCP, and EUS-FNA. The hemodynamics of gastric varices was evaluated utilizing 3dimentiomal computed tomography and/or angiography. Results: In 7 patients (chronic pancreatitis; 1, pancreatic carcinoma; 5,metastatic pancreatic carcinoma; 1), the gastric varices were visualized by endoscopy. The frequency of existence of the gastric varices was 2.3% in chronic pancreatitis and 8.3% in pancreatic carcinoma. The endoscopic features of those gastric varices were identified as the widespread tortuous gastric-varices locating from the cardia to lower gastric body. These findings were seen in all cases. Angiographic analysis of variceal hemodynamics revealed that these gastric varices were formed by two routes; 1: the collaterals from the short gastric vein to the portal vein via coronary veins, 2; the collaterals from short gastric vein to the portal vein via gastro-epiproic vein. Conclusion: The endoscopic feature of gastric varices in patient with left-sided portal hypertension due to the pancreatic disease was the widespread tortuous gastric-varices locating from the cardia to lower gastric body, reflecting the portovariceal hemodynamics.
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