Recurrence factors studied by percutaneous transpepatic portography before and after endoscopic sclerotherapy for esophageal varies

Takase, Yasuhiro; Shibuya, Susumu; Chikamori, Fumio; Orii, Kazuo; Iwasaki, Yoji

doi:10.1002/hep.1840110303

Cited by 82 publications

(45 citation statements)

References 22 publications

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“…2). We reported previously [7]that the recurrence rates of esophageal varices within 2 years after EE with complete and incomplete embolization of supply routes were 6.7 and 70%, respectively. Because of this result, we consider that complete EE is the first choice for the treatment of esophageal varices.…”

Section: Discussionmentioning

confidence: 99%

“…Their method tends to be inferior to endoscopic variceal ligation [6]because few endoscopists can accurately inject a sclerosant intravariceally into the blood supply. Because the recurrence rate within 2 years after EE was much lower with complete embolization of varix-associated supply routes than after incomplete embolization [7], we believe that the embolization of all associated supply routes is essential for the treatment of varices. EE requires knowledge of the portoazygos venous anatomy and quick identification of the anatomy on endoscopic varicography.…”

Section: Introductionmentioning

confidence: 99%

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Correlation between Endoscopic and Angiographic Findings in Patients with Esophageal and Isolated Gastric Varices

Chikamori¹,

Kuniyoshi²,

Shibuya

et al. 2001

Dig Surg

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Background/Aim: The correlation between angiographic vascular patterns and endoscopic findings in portal hypertension is not sufficiently known, and knowledge of the vascular anatomy may contribute to an improvement in endoscopic embolization and transjugular retrograde obliteration procedures. We propose a new vascular map that should prove useful for this purpose. Methods: Between April 1985 and December 1997 we performed percutaneous transhepatic portography in a selected group of 75 patients (16 women and 59 men), aged 43–71 years, from whom informed consent was obtained. All patients had been diagnosed endoscopically as having either esophageal or isolated gastric varices. According to the Child-Pugh classification, class A, B, and C cirrhosis was seen in 19, 40, and 16 patients, respectively. We created a vascular map of esophageal and isolated gastric varices, based on the opacification of the portal venous collaterals on percutaneous transhepatic portography. We compared the patients in both variceal groups in terms of portal venous pressure, main blood supply, and drainage routes. Results: We found that the portal collateral system was divided into two systems: the portoazygos venous system and the portophrenic venous system. The former contributed to the formation of esophageal and cardiac varices and the latter to the formation of isolated gastric varices located at the fundus or at both the cardia and fundus. The left gastric vein participated as blood supply in 70% of the isolated gastric varices and in 100% of the esophageal varices (p < 0.01). The posterior gastric vein participated as blood supply in 70% of the isolated gastric varices and in 24% of the esophageal varices (p < 0.01). We classified the main blood drainage routes of isolated gastric varices functionally into three types: gastrorenal shunt (85%), gastrophrenic shunt (10%), and gastropericardiac shunt (5%). The portal venous pressure in patients with esophageal varices was 358 ± 66 mm H₂O, whereas in patients with isolated gastric varices it was 262 ± 44 mm H₂O (p < 0.01). Conclusion: We suggest that this new vascular map will be useful in endoscopic embolization and transjugular retrograde obliteration procedures for esophageal and isolated gastric varices.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Correlation between Endoscopic and Angiographic Findings in Patients with Esophageal and Isolated Gastric Varices

Chikamori¹,

Kuniyoshi²,

Shibuya

et al. 2001

Dig Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…This method tends to be inferior to endoscopic variceal ligation [3]because few endoscopists can inject sclerosant intravariceally into the blood supply accurately. Because the recurrence rate within 2 years after EE was much lower with complete embolization [7], we believe that the embolization of all associated supply routes is essential for the treatment of varices.…”

Section: Discussionmentioning

confidence: 99%

“…We have used the latter method, known as endoscopic embolization (EE). Previously, we have reported that complete embolization of esophageal varices and their blood supply might help to reduce the rate of recurrence [7]. However, the portal hemodynamic changes following EE have yet to be determined.…”

Section: Introductionmentioning

confidence: 99%

Short-Term Portal Hemodynamic Effects of Endoscopic Embolization for Esophageal Varices

Chikamori¹,

Kuniyoshi²,

Shibuya

et al. 2000

Dig Surg

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Background/Aim: Endoscopic embolization (EE) is a specialized treatment that obliterates esophageal varices along with their associated blood supply. The purpose of this study was to investigate the short-term effects of EE for esophageal varices on portal hemodynamics and liver function. Methods: Thirty patients with esophageal varices were included in this study. The portal blood flow was measured by an ultrasonic duplex Doppler system before and after EE. EE was performed by freehand intravariceal injection of 5% ethanolamine oleate with iopamidol with the aid of a balloon attached to the tip of an endoscope under fluoroscopy. Results: For the blood supply system, endoscopic varicography at the time of EE was able to show the vessels of the cardiac branch of the left gastric vein in 93% of the cases, the cardiac venous plexus in 90%, the trunk of the left gastric vein in 27%, the lesser curvature branch of the left gastric vein in 10%, the fundic branch of the short gastric vein in 13%, and the posterior gastric vein in 13%. For the blood drainage system, endoscopic varicography was able to show the paraesophageal vein in 39% of the cases, the inferior phrenic vein in 17%, and the mediastinal vein in 13%. No clotting was detected after EE in the intra- and extraportal veins in any of the cases. The flow velocities in the main portal vein before and after EE were 14.2 ± 3.2 and 15.5 ± 3.5 cm/s, respectively, showing no significant change. The cross-sectional area of the portal vein before and after EE was 0.96 ± 0.21 and 1.04 ± 0.23 cm², and the flow volume of the portal vein was 817 ± 288 and 930 ± 189 ml/min, both also showing no significant change. The blood laboratory parameters showed no significant change after EE. Conclusions: We conclude that neither portal blood flow nor liver function were damaged by EE, although both the varices and their associated blood supply were obliterated.

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“…EVL and extravariceal EIS both eradicate varices locally, with no effect on interconnecting perforating or feeding vessels [41] . Takase et al [45] concluded that feeder vessels must be obliterated to prevent recurrence.…”

Section: Combination Of Endo�copic Injection �Clerotherapy and Endo�cmentioning

confidence: 99%

New methods for the management of esophageal varices

Yoshida

Mamada²,

Taniai³

et al. 2007

WJG

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Recurrence factors studied by percutaneous transpepatic portography before and after endoscopic sclerotherapy for esophageal varies

Cited by 82 publications

References 22 publications

Correlation between Endoscopic and Angiographic Findings in Patients with Esophageal and Isolated Gastric Varices

Correlation between Endoscopic and Angiographic Findings in Patients with Esophageal and Isolated Gastric Varices

Short-Term Portal Hemodynamic Effects of Endoscopic Embolization for Esophageal Varices

New methods for the management of esophageal varices

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