The diagnosis of gastric varices may be difficult due to their anatomic location and morphology. In this abstract we describe a case of gastric varices, of which a duplex Doppler sonography was useful in the diagnosis, that was initially suggested as submucosal tumor of the stomach by barium studies and endoscopy.
Aged ; Case Report ; Esophageal and Gastric Varices/*ultrasonography ; Female ; Human

PURPOSE: To demonstrate the clinical usefulness of ultrasonography for detecting esophageal varices. MATERIALS AND METHODS: In 20 cases of esophaged varix, the authors analysed the transabdominal ultrasono-graphicfindings of the esophagogastric junction and compared mural thickness, the anteroposterior diameter of theesophagus, and the echogenic nature of the esophageal mucosal layer with those of 78 normal patients. RESULTS:The anterior and posterior mural thickeness of normal esophagus was 2.2 +/-0.7 and 2.4 +/-0.8mm re-spectively, butfor variceal esophagus, the corresponding readings were 5.9 +/-1.3 and 5.2 +/-1.3mm respective-ly. Theanteroposterior diameter of normal esophagus was 7.9 +/-2.1mm and that of variceal esophagus was 1 4 . 0 +/-1.8mm.There was a stastically significant difference (p<0.01) in mural thickness and anteroposterior diameter of theesophagus between a normal and variceal patient with regard to change of echogenic nature at the esphagogastricjunction. Normal esophageal mucosa showed a thin and uniform echogenic line, but for variceal mucosa, theechogenic pattern was irregular, tortuous and thick. CONCLUSION: The athors believe that transabdominal US ishelpful for detecting esophageal varices in patients with liver cirrhosis and UGI bleeding. Important clinicallyuseful sonographic findings in diagnosing e-sophageal varix are as follows: 1) mural thickness more than 6mm; 2)anteroposterior diameter of the esopha-gus of more than 15mm; 3) irregular, tortuous and thickened echogenicmucosa.
Esophageal and Gastric Varices* ; Esophagogastric Junction ; Esophagus ; Hemorrhage ; Humans ; Liver Cirrhosis ; Mucous Membrane ; Reading ; Ultrasonography ; Varicose Veins

OBJECTIVE: To selectively visualize the left gastric vein (LGV) with hepatopetal flow information by non-contrast-enhanced magnetic resonance angiography under a hypothesis that change in the LGV flow direction can predict the development of esophageal varices; and to optimize the acquisition protocol in healthy subjects. MATERIALS AND METHODS: Respiratory-gated three-dimensional balanced steady-state free-precession scans were conducted on 31 healthy subjects using two methods (A and B) for visualizing the LGV with hepatopetal flow. In method A, two time-spatial labeling inversion pulses (Time-SLIP) were placed on the whole abdomen and the area from the gastric fornix to the upper body, excluding the LGV area. In method B, nonselective inversion recovery pulse was used and one Time-SLIP was placed on the esophagogastric junction. The detectability and consistency of LGV were evaluated using the two methods and ultrasonography (US). RESULTS: Left gastric veins by method A, B, and US were detected in 30 (97%), 24 (77%), and 23 (74%) subjects, respectively. LGV flow by US was hepatopetal in 22 subjects and stagnant in one subject. All hepatopetal LGVs by US coincided with the visualized vessels in both methods. One subject with non-visualized LGV in method A showed stagnant LGV by US. CONCLUSION: Hepatopetal LGV could be selectively visualized by method A in healthy subjects.
Abdomen ; Esophageal and Gastric Varices ; Esophagogastric Junction ; Healthy Volunteers ; Magnetic Resonance Angiography ; Methods ; Ultrasonography ; Veins

Esophageal and Gastric Varices ; drug therapy ; Gastric Fundus ; drug effects ; Hemorrhage ; drug therapy ; Hemostasis ; Humans ; Plant Extracts ; therapeutic use ; Ultrasonography ; methods

BACKGROUND/AIMS: Congestive duodenopathy could be associated with liver cirrhosis with portal hypertension. The aims of this study were to assess the incidence of duodenopathy and to evaluate the relationship between duodenopathy and the presence of esophageal varices and portal hypertensive gastropathy in cirrhotic patients. MEHTODS: A total of 56 patients with liver cirrhosis and 481 controls were taken upper endoscopic examination. RESULTS: Prevalence of duodenopathy was significantly higher in the liver cirrhosis group (26.8%) compared to the control group (6.9%), although positive rate of Helicobacter pylori was significantly lower in the liver cirrhosis group. Duodenal erosions in cirrhotic patients were predominately located in 2nd portion of duodenum compared to contol group and tended to be circular or linear along the Kerck's ring. Vascular congestion was evident in 5 of the 10 cases. Presence of duodenal lesions had no relationship with the size and extent of esophageal varices and congestive gastropathy. CONCLUSIONS: Although histology of duodenopathy tends to show vascular congestion in patients with liver cirrhosis, few clinical markers of portal hypertension support them. Therefore, further studies including endoscopic ultrasonogram are needed to demonstrate the pathogenesis of the duodenal lesions in patients with liver cirrhosis.
Biomarkers ; Duodenum ; Esophageal and Gastric Varices ; Estrogens, Conjugated (USP) ; Helicobacter pylori ; Humans ; Hypertension, Portal ; Incidence ; Liver Cirrhosis* ; Liver* ; Prevalence ; Ultrasonography

Endoscopic ultrasound (EUS) offers access to many intra-abdominal vessels that until now have only been accessible to the surgeon and interventional radiologist. In addition to assisting with diagnostics, this unique access offers the potential for therapeutic intervention for a host of indications. To date, this has had the most clinical impact in the treatment of gastroesophageal varices, with EUS-guided coil and glue application growing in use worldwide. Although randomised controlled trial data is lacking, we discuss the growing body of literature behind EUS-guided therapy in the management of varices. EUS has also been used in specialized centres to assist in non-variceal gastrointestinal bleeding. The treatment of bleeding from Dieulafoy lesions, tumours and pancreatic pseudoaneurysms has all been described. The potential applications of EUS have also extended to the placement of portal vein stents and porto-systemic shunts in animal models. As medicine continues to move to increasingly less invasive interventions, EUS-guided therapies offer substantial promise for the safe and effective delivery of targeted treatment for a widening array of vascular disorders.
Adhesives ; Aneurysm, False ; Endosonography ; Esophageal and Gastric Varices ; Hemorrhage ; Models, Animal ; Portal Pressure ; Portal Vein ; Stents ; Ultrasonography ; Varicose Veins

BACKGROUNDS/AIM: Patients with liver cinhosis suffer from indigestion, abdominal discamfort, or dysphagia, but causes of these symptoms are unknown. Ascites, esophageal varix, fiequency of variceal ligatian, and poor residual liver function are considered as the causes, despite no consistent result. There has been no report about pogestaone known to decrease the pressure of lower esophageal sphincter at pregnancy in cirrhotic patients. We evaluated the factors affecting gastroesaphageal reflux and esophageal matility disarder in patients with cirrhosis. SUBJECTS AND METHODS: Between May 1997 and September 1998, 24 cinhotic patients(18 men and 6 women, mean age 51.8+/-9.7yr) were enrolloed. All patients were subjected to abdominal ultrasonography, esophageal manometry, ambulatary 24hr esophageal pH monitoring, esophagogastroduodenoscopy, and serum levels of esttogen and pogesterone. After ascites was conttolled, these studies were performed again in 5 patients. RESULTS: 1) Thae was no correlation between amount of ascites and esophageal motility disceder, gastroesophageal reflux. But, after ascites was controlled, lower esaphageal pressure tended to increase. 2) There was no correlation between grade of esophageal varix and esophageal manometric abnormalities. 3) There was inverse carrelation between frequency of esophageal variceal ligation and upper esophageal pessure. 4) There was invase correlation between lower esophageal pressure and serum level of esttogen, progesterone. 5) There was no correlation between severity of liver cirrhosis, age and esophageal motility disceders, pstroesophageal reflux. CONCLUSIONS: Factors affecting esophageal motility disorders in cirrhatic patients are ammout of ascites, frequency of esophageal variceal ligations, and serum levels of estrogen and progesterrone.
Ascites ; Deglutition Disorders ; Dyspepsia ; Endoscopy, Digestive System ; Esophageal and Gastric Varices ; Esophageal Motility Disorders* ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Estrogens ; Female ; Fibrosis ; Gastroesophageal Reflux* ; Humans ; Ligation ; Liver Cirrhosis* ; Liver* ; Male ; Manometry ; Pregnancy ; Progesterone ; Ultrasonography

BACKGROUND: Propranolol is only known drug effective in preventing variceal bleeding by ameliorating portal hypertension. The optimal dose of propranolol is variable due to racial differences of cardiovascular receptor sensitivity. In this prospective study, we tried to evaluate the effect of propranolol on portal hypertension, required optimal dose and to find out factors that influence drug responses in Korean cirrhotic patients with portal hypertension. METHODS: This study included 25 patients with liver cirrhosis who had variceal bleeding episode. Propranolol was given orally at an initial dose of 20 mg twice daily. The dose was subsequently adjusted over a period of 2 days until the resting heart rate had been reduced by 25% or less than 55 beats per minute. The hemodynamic studies including measurements of heart rate (HR), mean blood pressure (MBP), hepatic venous pressure gradient (HVPG), portal venous flow (PVF) were evaluated both prior to and 3 months after commencing treatment. Patients who showed a reduction in HPVG of more than 20% of baseline or absolute value under 12 mmHg were defined as being responders. RESULTS: The mean required dose of propranolol to reach target heart rate was 165 mg (80~280 mg). Propranolol induced significant reduction in HVPG (-29.0+/-21.4%, p<0.01), PVF (-19.6+/-17.8%, p<0.01) and HR (-29.3+/-9.1%, p<0.01). Drug responders were 15 (60%) and non-responders were 10 (40%). There was no significant factor for drug responders in multivariate analysis. The main complication of propranolol was dizziness with incidence of 24%, but was not serious enough to stop the administration of the drug. CONCLUSION: Propranolol is effective in reducing portal pressure in Korean cirrhotic patient and considered as relatively safe, and might be useful in preventing variceal bleeding. To obtain effective improvement of portal hypertension, it is necessary to increase the dosage until the targeted heart rate is reached when the measurement of HVPG is not be available.
Blood Pressure ; Dizziness ; Esophageal and Gastric Varices ; Heart Rate ; Hemodynamics ; Humans ; Hypertension ; Hypertension, Portal* ; Incidence ; Liver Cirrhosis ; Multivariate Analysis ; Portal Pressure* ; Propranolol* ; Prospective Studies ; Ultrasonography ; Venous Pressure

Liquid tissue adheisve, Histoacryl (n-butyl-2-cyanoacrylate) has been used for the treatment of gastric variceal bleeding. The techniques are as follows: 0.5cc Histoacryl mixed with Lipiodol per each injection are used. 3 to 4 injections are usually required for large variceal convolutes under the fluoroscopic visualization after the injection of Histoacryl. Complications of sclerotherapy with Histoacryl are bleeding, perforation, stenosis and embolism depending on the concentration and amount used, as well as the intensity of the treatment. Here we describe a case report developing portal and splenic vein thrombosis as a side effect after Histoacryl injection therapy for the treatment of gastric varix bleeding, A 59-year-old male patient with liver cirrhosis was admitted due to acute gastric varix bleeding. The control of gastrie variceal bleeding was achieved by several injections of 0.7c mixture of 0.5cc histoacryl and 0,8cc Lipiodol. However, simple X-ray and ultrasonography revealed the elements of Histoacryl-lipiodol mixture in the portal and splenic vein.
Constriction, Pathologic ; Embolism ; Enbucrilate* ; Esophageal and Gastric Varices* ; Ethiodized Oil ; Hemorrhage ; Humans ; Liver Cirrhosis ; Male ; Middle Aged ; Sclerotherapy ; Splenic Vein* ; Thrombosis* ; Ultrasonography

BACKGROUND/AIMS: Gastroesophageal variceal hemorrhage is a common complication of portal hypertension. Endoscopic therapy is currently recommended for preventing gastroesophageal variceal rebleed. However, the rate of variceal rebleed and its associated mortality remain concerning. This study is aimed at differentiating patient response to endoscopic therapy based on endoscopic ultrasound (EUS) findings. METHODS: One-hundred seventy patients previously treated with repeat endoscopic therapy for secondary prophylaxis were enrolled and classified into two groups based on treatment response. Prior to consolidation therapy, all patients received an EUS examination to observe for extraluminal phenomena. All available follow-up endoscopic examination records were retrieved to validate study results. RESULTS: Of the 170 subjects, 106 were poor responders, while 64 were good responders. The presence of para-gastric, gastric perforating, and esophageal perforating veins was associated with poor patient response (p < 0.001). The odds ratio for para-gastric veins was 5.374. Follow-up endoscopic findings for poor responders with incomplete variceal obliteration was closely correlated with the presence of para-gastric veins (p=0.002). CONCLUSIONS: The presence of para-gastric veins is a characteristic of poor response to endoscopic therapy for treating gastroesophageal varices. Early identification of this subgroup necessitates a change in course of treatment to improve overall patient outcome.
Cyanoacrylates ; Endosonography ; Esophageal and Gastric Varices ; Follow-Up Studies ; Hemorrhage ; Humans ; Hypertension, Portal ; Mortality ; Odds Ratio ; Risk Assessment ; Ultrasonography* ; Varicose Veins* ; Veins