Utility of Transabdominal Ultrasonography Enhanced by Oral Cellulose-Based Contrast Agent in Depicting Varices at Cardia and Fundus

Abstract

The use of transabdominal color Doppler ultrasound after oral administration of an oral cellulosebased contrast agent (TUS-OCCA) in depicting varices at the cardia and fundus was explored. Both gastroscopy and transabdominal color Doppler ultrasound (TUS) were performed for this purpose, with gastroscopy serving as the gold standard. Patients were assigned by TUS protocol to one of three groups: TUS + empty stomach (TUS-ES); TUS + oral water intake (TUS-OW); and TUS-OCCA. TUS-based grading of varices reflected venous diameters and blood flow velocities, designated as follows: Ux = difficulty discerning gastric fundus and cardia or delineating varices; U0 = no detectable varices; U1 = diameter <5 mm, flow rate <10 cm/s; U2 = diameter <5 mm, flow rate 10 cm/s; U3 = diameter 5À10 mm, flow rate <10 cm/s; U4 = diameter 5À10 mm, flow rate 10 cm/s; and U5 = diameter >10 mm, any flow rate. Between August 2016 and August 2019, 239 patients with cirrhosis were enrolled prospectively, including bleeding (n = 71) and non-bleeding (n = 168) groups. Varices were directly observed in 10.5% (25/239) of TUS-ES group members, compared with 59.2% (58/98) of the TUS-OW group and 89.6% (104/116) of the TUS-OCCA group; all detection rates differed significantly (TUS-OCCA > TUS-OW > TUS-ES, p < 0.05). TUS-based grading (as defined) revealed the following patient distribution: Ux, n = 34; U0, n = 18; U1, n = 50; U2, n = 41; U3, n = 16; U4, n = 46; U5, n = 34. In grading by variceal diameter, overall correspondence between TUS and gastroscopy was 93% (174/187). TUS-OCCA greatly improved rates of detection of varices at the cardia and fundus, offering a new method by which diagnosis and quantitative grading may be achieved and affording an excellent, non-invasive approach to dynamic follow-up. (

Enhanced Resorption of Liposomal Packed Vitamin C Monitored by Ultrasound

“…Liur et al developed a method of transabdominal ultrasound after oral administration of an echo rich cellulose-based gastric ultrasound contrast agent (TUS-OCCA) [53]. In contrast to the echo rich cellulose-based agent (Huzhou East Medical Devices, Huzhou, Zhejiang, China) that remains in the intestinal lumen, our microbubbles migrated through the intestinal wall and transferred the active substance, in this case ascorbic acid, into the blood circulation and the cells [54]. Of course, the possibilities for liposomal packing and the successive resorption enhancement are not limited to vitamin C. With little adjustments to the procedure, enhanced resorption after liposomal packing might be possible for a large variety of essential nutrients.…”