Extrahepatic metastases of HCC are not rare. The possibility of extrahepatic metastases and the clinical features of extrahepatic metastases should be considered when examining patients with HCC, particularly those with advanced intrahepatic tumors, to enable precise evaluation of the spread of HCC and determination of the appropriate treatment method.

Bleeding from ectopic varices, which is rare in patients with portal hypertension, is generally massive and life-threatening. Forty-three patients were hospitalized in our ward for gastrointestinal bleeding from ectopic varices. The frequency of ectopic varices was 43/1218 (3.5%) among portal hypertensive patients in our ward. The locations of the ectopic varices were rectal in thirty-two, duodenal in three, intestinal in two, vesical in three, stomal in one, and colonic in two patients. Endoscopic or interventional radiologic treatment was performed successfully for ectopic varices. Hemorrhage from ectopic varices should be kept in mind in patients with portal hypertension presenting with lower gastrointestinal bleeding.

We studied 118 patients using endoscopic color Doppler ultrasonography (ECDUS) to evaluate perforating veins of esophageal varices. The ECDUS was performed with a PENTAX FG‐32UA or FG‐36UX (7.5 MHz, convex type) and a HITACHI EUB 565 was used as a display device. We defined the perforating veins as communicating vessels between esophageal varices and paraesophageal veins. We evaluated the detection rate and the direction of blood flow in the perforating veins. Color flow images of perforating veins were obtained in 43 of the 118 (36.4%) patients. We classified the perforating veins into three types. Type 1 was characterized as an inflow type from paraesophageal veins to esophageal varices, Type 2 as an outflow type from esophageal varices to paraesophageal veins and Type 3 as a mixed type showing both inflow and outflow. Type 1 was recognized iri 37 (86.0%), Type 2 in four (9.3%) and Type 3 in two (4.7%) of 43 patients. We conclude that ECDUS is a useful modality for obtaining diagnostic color flow images of perforating veins, and for evaluating the blood flow direction in perforating veins. (Dig Endosc 1996; 8: 180‐183)

Endoscopic ultrasonographic evaluation of the hemodynamics in esophageal varices before and after EIS enables prediction of early variceal recurrence.

ECDUS is a useful modality for diagnosis of the hemodynamics of gastric varices and may allow the prediction of a high risk for hemorrhage.

A 53-year-old man was admitted to our hospital in August 1997 with enlarged gastric varices. Computed tomography (CT) showed splenic vein occlusion, gastric varices, and extra-gastric wall collateral veins. Color flow images of gastric varices were clearly visualized, and the velocity in the gastric varices was 19.6 cm/s via endoscopic color Doppler ultrasonography (ECDUS). The patient was diagnosed with gastric varices according to angiographic findings of splenic vein occlusion, and splenic arterial embolization was performed. Two weeks after the splenic arterial embolization, CT showed peripheral areas of low attenuation in the spleen, due to splenic infarction, with 70% of the spleen volume showing low attenuation. Eight months after the splenic arterial embolization, ECDUS revealed a decrease in gastric variceal color flow images, with the velocity in the gastric varices being 10.3 cm/s.

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Background and aims:The study’s aim was to evaluate the efficacy of endoscopic injection sclerotherapy (EIS) compared with endoscopic band ligation (EBL) in treating rectal varices.Methods:Data from 34 consecutive patients who underwent endoscopic treatments for rectal varices were analyzed. The clinical outcomes, including complications, related to EIS or EBL retrospectively.Results:In 25 of the 34 patients, EIS was performed weekly 2–5 times (mean, 2.7), and the total amount of sclerosant ranged from 3.2 to 12.0 mL (mean, 5.2 mL). After EIS, colonoscopy revealed shrinkage of the rectal varices in all 25 patients, with no complications reported. In 9 of the 34 patients, EBL was performed weekly 1–3 times (mean, 2.2), and bands were placed on the varices at 2–12 sites (mean, 8.0). After EBL, colonoscopy revealed ulcers and shrinkage of the rectal varices in all nine patients, eight of whom experienced no operative complications. The overall recurrence rate for rectal varices was 10 of 24 (41.7%), including 5 of 9 (55.6%) receiving EBL and 5 of 15 (33.3%) receiving EIS, over a 1-year follow-up period (n = 24). All four patients with recurrence of bleeding were EBL cases, versus no EIS cases (P < 0.05).Conclusion:EIS appears superior to EBL with regard to effectiveness and complications after endoscopic treatment of rectal varices.