HEMODYNAMIC MECHANISM OF ESOPHAGEAL VARICES

Abstract

We investigated the correlation between the collaterals around the esophagus and recurrence of esophageal varices in patients with portal hypertension who had undergone endoscopic injection sclerotherapy (EIS). In patients with portal hypertension, many types of collaterals around the esophagus were visualized by endoscopic ultrasonography (EUS). The collaterals outside the esophageal wall detected by EUS were divided into two groups according to the location of the veins: peri‐esophageal collateral veins (peri‐ECV) and para‐esophageal collateral veins (para‐ECV) Perforating veins are those that have penetrated the esophageal wall and have connected with either peri‐ECV or para‐ECV. We demonstrated that severe peri‐ECV and large perforating veins play an important role in the development of esophageal varices in untreated patients with portal hypertension. The results of our investigation have shown that detection of peri‐ECV and perforating veins by EUS and treatment of them by EIS appears to be important for the treatment of esophageal varices. The disappearance of peri‐ECV by EIS is essential for reducing the recurrence rate of esophageal varices. To prevent variceal recurrence, a mucosal fibrosing method using argon plasma coagulation has been widely performed in Japan. If EUS abnormalities are associated with variceal recurrence, we recommend the use of the mucosal fibrosing method. In conclusion, the presence of severe peri‐ECV and large perforating veins in the esophageal wall strongly correlate with the recurrence of esophageal varices in patients with portal hypertension. An understanding of these EUS abnormalities on the basis of hemodynamics around the esophagus is important for the management of esophageal varices in patients with portal hypertension.