Endoscopic Color Doppler Ultrasonographic Evaluation of Gastric Varices Secondary to Left-Sided Portal Hypertension

Abstract

Gastric varices that arise secondary to the splenic vein occlusion can result in gastrointestinal hemorrhaging. Endoscopic color Doppler ultrasonography (ECDUS) was performed in 16 patients with gastric varices secondary to splenic vein occlusion. This study retrospectively evaluated the role of ECDUS in the diagnosis of gastric varices secondary to splenic vein occlusion. Thirteen patients had co-existing pancreatic diseases: 8 with chronic pancreatitis, 4 with cancer of the pancreatic body or tail and 1 with severe acute pancreatitis. Of the remaining 3 patients, 1 had myeloproliferative disease, 1 had advanced gastric cancer, and the third had splenic vein occlusion due to an obscure cause. The endoscopic findings of gastric varices were: variceal form (F) classified as enlarged tortuous (F2) in 12 cases and large, coil-shaped (F3) in 4 cases, and positive for erosion or red color sign of the variceal surface in 4 cases and negative in 12 cases. ECDUS color flow images of gastric variceal flow clearly depicted a round fundal region at the center, with varices expanding to the curvatura ventriculi major of the gastric body in all 16 cases. The velocities of F3 type gastric varices were significantly higher than those of the F2 type. The wall thickness of varices positive for erosion or red color sign was significantly less than the negative cases. I conclude that ECDUS color flow images of gastric variceal flow depicted specific findings of gastric varices secondary to splenic vein occlusion at the round fundal region at the center, with varices expanding to the curvatura ventriculi major of the gastric body.

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“…In a previously case, endoscopic color Doppler ultrasonography (ECDUS) analysis of gastric varices due to splenic vein occlusion clearly revealed a round fundal region at the center, with varices that expanded to the curvature ventriculi major of the gastric body [3]. Here, we present a case with gastric varices secondary to splenic vein occlusion which were diagnosed by ECDUS, with detection of the bleeding site.…”

Sinistral portal hypertension associated with pancreatic pseudocysts - ultrasonography findings: A case report

“…Compared with other radiological findings, ultrasonographic imaging is clearer to indicate varices if the splenic vein is only partially thrombosed[ 15 ]. The pattern and velocity of blood flow and complications are all clearly demonstrable by ultrasonographic imaging, and it is inexpensive, convenient, quick, safe and, we think, has the flexibility to examine pathology in a variety of anatomical planes[ 15 , 16 ]. Surgical findings in this case shown dilated and tortuous veins in the surrounding of omentum, mesentery, stomach, normal liver, an arched protrusion on the upper margin of the pancreas.…”

Endoscopic ultrasonography - emerging applications in hepatology

“…The presence of isolated gastric varices without esophageal varices can also be observed in patients with non-cirrhotic portal hypertension, which can occur in patients with splenic vein obstruction (left-sided portal hypertension). The role of the EUS color Doppler in patients with isolated gastric varices related to splenic vein occlusion has also been studied by Sato et al[ 50 ]. In this study the authors have provide specific findings that may be regarded as hallmarks of gastric varices due to splenic vein occlusion, namely a flow clearly depicted a round fundal region at the centre, with varices expanding to the curvatura major of the gastric body.…”