1/25. Control of solitary gastric fundal varices and portosystemic encephalopathy accompanying liver cirrhosis by balloon-occluded retrograde transvenous obliteration (B-RTO): a case report.In a patient with liver cirrhosis complicated by solitary gastric fundal varices and portosystemic encephalopathy, Balloon-occluded retrograde transvenous obliteration (B-RTO) of the varices was performed. The gastric varices were decreased in size 2 weeks after treatment and had not recurred after 1 year. B-RTO successfully occluded the portosystemic shunt (gastrorenal shunt). Accordingly, the patient's blood ammonia levels, total bile acid level, and 15 min retention rate of indocyanine green decreased, and his hepatic encephalopathy improved. However, since consecutive increase in blood flow through the portal collateral vessels except for gastrorenal shunt vessel at 6 months and 1 year after B-RTO was noted, further careful follow-up may be required.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/25. blood supply routes of recurrent esophageal varices following endoscopic embolization.BACKGROUND/AIM: The blood supply routes of recurrent esophageal varices following complete endoscopic embolization (EE) are not yet known. The purpose of this study is to identify these blood supply routes by comparing endoscopic varicography and percutaneous transhepatic portography (PTP). methods: Eleven cases of recurrent esophageal varices following EE are included in this study. The blood supply routes of primary and recurrent varices were analyzed by comparing the varicography obtained at the initial and repeat EE with PTPs before and after the initial EE. RESULTS: Endoscopic varicography at the time of initial EE could show the vessels of the left gastric vein (LGV) system, such as the cardiac branch of the LGV, and the cardiac venous plexus (CP) in 100% of cases, and the trunk of the LGV in 73% (8/11) of cases, whereas the posterior gastric vein was seen in only 18% (2/11) of cases. PTP performed 2 weeks after the initial EE confirmed that the routes visualized by endoscopic varicography could be obliterated in 10 of 11 cases. The blood supply routes of recurrent varices, demonstrated by varicography, were the vessels of the short gastric vein (SGV) system, such as the fundic branch of the SGV or the posterior gastric vein in 82% (9/11) of cases, and the partially reformed fine CP in 27% (3/11) of cases. Varicography revealed the remnant vessels of the LGV in only 1 case. CONCLUSIONS: The primary esophageal varices are supplied with blood mainly from the cardiac branch of the LGV through the CP. However, the blood supplies of recurrent varices following EE come from the fundic branch of the SGV or the posterior gastric vein. We conclude that three-dimensional obliteration of esophageal varices and their feeders, the LGV and SGV systems, is completed by initial and repeat EEs.- - - - - - - - - - ranking = 1.5keywords = vessel (Clic here for more details about this article) |
3/25. Massive splenic infarction in cirrhosis: report of a case with spontaneous disappearance of hypersplenism.A cirrhotic patient with massive splenic infarction is described. Celiac angiography showed normally opacified splenic artery and vein and a markedly enlarged spleen with large avascular zones. splenic infarction was associated with the spontaneous disappearance of a syndrome of hypersplenism. The spleen was surgically removed. Histological examination showed multiple thromboses of the small arterial and venous vessels. The cause of this infarct remained unclear.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/25. Adherence of cyanoacrylate which leaked from gastric varices to the left renal vein during endoscopic injection sclerotherapy: a histopathologic study.We report a case involving leakage of cyanoacrylate (CA) to the inferior vena cava (IVC) through a gastrorenal shunt and left renal vein. A 72-year-old man with liver cirrhosis was admitted to our hospital to undergo emergency treatment for massive hemorrhage of gastric varices. Endoscopic injection sclerotherapy (EIS) using CA was performed on the varices. Radiographic fluoroscopy revealed that most of the injected CA had adhered firmly to the gastric varices, but a certain portion of the CA had flowed to the IVC through the gastrorenal shunt and left renal vein. At that point, the patient did not complain of any symptoms. However, 6 months later, he died of hepatic failure and an autopsy was performed. Histopathologic examination of the wall of the IVC and renal vein, to which CA had adhered, revealed that the CA was covered with endothelial cells of the vessel and no nearby thrombus was present. Long-term anticoagulant therapy may not be indicated in cases of leakage of CA from the gastric varices to other veins, since the leaked CA may be readily covered with endothelium without thrombus formation as in our patient. It is possible for CA to flow to the IVC and have a fatal impact. Our patient was fortunate, and for safe EIS it is important that these complications are prevented.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/25. Ruptured gastric fundal varices treated with endoscopic variceal ligation and transjugular retrograde obliteration: case report.Therapeutic modalities for the obliteration of collateral vessels connecting the portal venous system with the systemic circulation, transjugular retrograde obliteration (TJO) and balloon-occluded retrograde transvenous obliteration have recently been developed, and several satisfactory results have been reported with their use. We report a case of ruptured gastric fundal varices treated with TJO after endoscopic variceal ligation (EVL). In our case, variceal bleeding was controlled successfully with EVL and varices were eradicated with TJO.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/25. Laparoscopic splenectomy for variceal bleeding with non-cirrhotic portal vein thrombosis: a case report.A 57-year-old man was referred to our hospital for treatment of refractory gastric bleeding from gastric varices secondary to portal vein thrombosis. The patient's liver function tests and coagulation profile were normal. The venous phase of the superior mesenteric arteriogram, on the other hand, showed superior mesenteric vein-portal vein occlusion with surrounding hepatopetal variceal collaterals. The venous phase of the splenic arteriogram additionally showed splenic vein occlusion and collateral vessels from the gastric and retroperitoneal regions flowing into a portal cavernous transformation. gastroscopy confirmed that the patient had gastric varices in the cardia. We performed laparoscopic splenectomy to treat refractory gastric bleeding from varices and symptomatic hypersplenism. The postoperative course was uneventful; the patient's gastric varices were less prominent on follow-up gastroscopy and the hematologic profile returned to normal. Extrahepatic portal vein thrombosis is the leading cause of variceal hemorrhage in patients with healthy livers. There is a consensus in the literature that splenectomy alone is of minimal value in preventing variceal bleeding in portal vein thrombosis. splenectomy is, however, indicated in cases in which the patient has hepatopetal collaterals from the mesenteric vein system and whose hemorrhagic gastric varices are related to splenic vein thrombosis as in our case.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/25. Distal embolization and local vessel wall ulceration after gastric variceal obliteration with N-butyl-2-cyanoacrylate: a case report and review of the literature.Repeated endoscopic injections of N-butyl-2-cyanoacrylate mixtures into large gastric varices in a single patient led to two complications: initially, pulmonary embolism, and later local ulceration of the wall of a varix. The latter resulted in massive uncontrollable hemorrhage that ultimately led to a fatal outcome. This case report also analyzes complications reported in the literature during similar endoscopic procedures for gastric varices.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
8/25. Variceal recurrence after endoscopic sclerotherapy associated with the perforating veins in lower esophagus independently.BACKGROUND/AIMS: The perforating veins as a lateral blood supply route for esophageal varices in lower esophagus are associated with the recurrence of esophageal varices after sclerotherapy, but not vessels at the esophagogastric junction as an ascending blood supply route. To date, however, frequency of association perforating veins alone with variceal recurrence has not been investigated. To clarify the influence of perforating veins alone on variceal recurrence after endoscopic injection sclerotherapy, we studied the prevalence of variceal recurrence in patients with perforating veins detected by endoscopic ultrasonography after treatment. METHODOLOGY: Forty-two patients who underwent injection sclerotherapy and received endoscopic ultrasonography after treatment to evaluate the effect on the collaterals around the esophagus, were studied. Subjects were classified in four groups according to endosonographic findings as follows: group A: perforating veins ( ) and vessels at esophagogastric junction ( ), group B: perforating veins ( ) and vessels at esophagogastric junction (-), group C: perforating veins (-) and vessels at esophagogastric junction ( ), group D: perforating veins (-) and vessels at esophagogastric junction (-). RESULTS: Variceal recurrence was observed in 60% (6/10) of patients in group A, 64.3% (9/14) of patients in group B, 33.3% (1/3) of patients in group C, 0% (0/15) of patients in group D, respectively. The prevalence of variceal recurrence was compared between the 4 groups. No significant difference between group A or C and B was noted, and there was a significant difference between group A or B and D. CONCLUSIONS: These results suggested that perforating veins are highly associated with variceal recurrence after sclerotherapy even if perforating veins are independent.- - - - - - - - - - ranking = 2.5keywords = vessel (Clic here for more details about this article) |
9/25. Perforating veins in recurrent esophageal varices evaluated by endoscopic color Doppler ultrasonography with a galactose-based contrast agent.BACKGROUND: We evaluated the usefulness of endoscopic color Doppler ultrasonography (ECDUS) with Levovist, a galactose-based contrast agents, for detecting veins in the esophageal wall in patients with recurrent esophageal varices after endoscopic therapies. methods: We compared vessel images detected prior to the use of contrast with those detected by enhanced ECDUS in 29 patients with recurrent esophageal varices. After the pre-contrast ECDUS examination, all 29 patients received Levovist intravenously, at a concentration of 300 mg/ml. A 7.5-ml dose of the contrast agent was injected at a slow infusion rate, of 1 ml/min. The perforating veins detected by ECDUS were classified, according to flow direction, into three different types. Type 1 showed inflow from the paraesophageal veins to the esophageal varices. Type 2 showed outflow from the esophageal varices to the paraesophageal veins, while type 3 was a mixed type with both inflow and outflow. For comparison, 26 patients without recurrent esophageal varices were studied. RESULTS: color flow images of perforating veins were obtained in 9 (31.0%) of the 29 patients with recurrent esophageal varices with pre-contrast ECDUS. The detection rate of perforating veins in the patients with recurrent esophageal varices (31.0%) was significantly higher than that in patients without recurrent esophageal varices (0 of 26; 0%) with pre-contrast ECDUS. color flow images of perforating veins were detected in 22 (75.9%) of the 29 patients with recurrent esophageal varices after Levovist contrast. On the other hand, color flow images of perforating veins were not detected in any of the 26 patients without recurrent esophageal varices after Levovist contrast. Type 1 perforating veins were recognized in 6 (20.7%) of the 29 patients, type 2 in 2 (6.9%) of the 29, and type 3 in 1 (3.4%) of the 29 prior to the use of contrast. After the enhanced ECDUS, type 1 perforating veins were recognized in 13 (44.8%) of the 29 patients, type 2 in 6 (20.7%) of the 29, and type 3 in 3 (10.3%) of the 29. All color-flow images detected with pre-contrast ECDUS were enhanced after Levovist contrast. CONCLUSIONS: Perforating veins can be detected at a high rate by ECDUS with Levovist in patients with recurrent esophageal varices after endoscopic therapy.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/25. Evaluation of arterial blood flow in esophageal varices via endoscopic color Doppler ultrasonography with a galactose-based contrast agent.BACKGROUND: We examined the usefulness of endoscopic color Doppler ultrasonography, using Levovist in evaluating the arterial blood flow, in patients with esophageal varices. methods: The study involved 110 patients with esophageal varices who were examined using endoscopic color Doppler ultrasonography (ECDUS). We compared vessel images detected by pre-contrast ECDUS with those detected by enhanced ECDUS. We evaluated the detection rate of the pulsatile wave, and measured systolic velocity and end-diastolic velocity. We calculated the resistance index (RI), which demonstrates the resistance of peripheral vessels in arterial flow. RESULTS: color flow images of the pulsatile wave were obtained by pre-contrast ECDUS in 3 (2.7%) of the 110 patients. color flow images of the pulsatile waves were obtained in 40 (36.4%) of the 110 patients by enhanced ECDUS using Levovist. That is, by using Levovist, a pulsatile wave could be delineated in 37 patients in whom pulsatile waves were previously undiagnosed via pre-contrast ECDUS. color flow images of the pulsatile waves were detected in 37 (37.7%) of the 98 F2 varices and in 3 (25.0%) of the 12 F3 varices. color flow images of the pulsatile wave were detected in 35 (40.2%) of the 87 red color (RC)( ) varices, and in 5 (21.7%) of the 23 RC( ) or RC ( ) varices. Next, we calculated the RI of the pulsatile wave, obtained by enhanced ECDUS using Levovist, in 40 patients. The RI ranged from 0.49 to 0.83 (mean, 0.67 /- 0.09); there were nine patients with RIs of less than 0.60, and all 9 of these patients had both F2 and RC( ) type varices (100%). CONCLUSIONS: Levovist contrast in ECDUS examinations suggests that arterial flow is involved in the formation of esophageal varices.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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