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 perforating 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 300mg/ml. A 7.5-ml dose of the contrast agent was injected at a slow infusion rate, of 1ml/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.     

Visualization of palisade veins in esophageal varices by endoscopic color Doppler ultrasonography

Background: Endoscopic color Doppler ultrasonography (ECDUS) is a useful modality for obtaining color flow images of esophageal varices. Levovist is a microbubble echo‐enhancing agent that improves Doppler ultrasound examination. This study is designed to evaluate the usefulness of ECDUS using Levovist in diagnosing palisade veins of esophageal varices. Methods: The study involved 67 patients with esophageal varices using ECDUS. All 67 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. We compared vessel images detected with precontrast with those detected by enhanced ECDUS. Results: Color flow images of palisade veins were obtained in 16 (23.9%) of the 67 patients with precontrast ECDUS. Vessel images of palisade veins were detected in 15 of 61 F2 type varices (24.6%) and in one of six F3 varices (16.7%). The color flows of these vessels showed a continuous wave on fast‐Fourier transform analysis. Sixteen palisade veins had velocities in the 3.3 cm/s?11.6 cm/s range. Color flow images of palisade veins were obtained in 27 (40.3%) of the 67 cases by enhanced ECDUS using Levovist. Palisade veins could be delineated after Levovist contrast in 11 patients who could not be detected on precontrast ECDUS. After Levovist contrast, color flow images detected with precontrast ECDUS were enhanced in all patients. Conclusion: Endoscopic color Doppler ultrasonography with Levovist contrast can improve the diagnostic quality of the palisade veins in esophageal varices.     

Experience with electronic radial endoscopic color Doppler ultrasonography in esophageal variceal patients

Background: Endoscopic color Doppler ultrasonography (ECDUS) is a method for detecting color flow images in blood vessels. In the present study, electronic radial ECDUS in cases of esophageal varices is described. Methods: Thirteen patients with esophageal varices were studied. The technique of ECDUS was performed using a Pentax EG3630‐UR (forward‐view) with a distal tip diameter of 12 mm. The instrument (electronic radial array) has a curved array scanning transducer with variable frequency (5.0, 7.5, 10.0 MHz) and B mode/color Doppler/power Doppler capability. A Hitachi EUB 6500 was used for the display, providing a 270° image. We monitored the color flow images of esophageal varices, paraesophageal veins and perforating veins using this technique. Results: Color flow images of esophageal varices and paraesophageal veins were obtained in 13 of the 13 patients, whereas color flow images of perforating veins were obtained in four of the 13 patients (30.8%). The 13 esophageal varices exhibited velocities ranging between 3.0 and 11.7 cm/s (mean = 6.3 cm/ s). The forward‐viewing optics facilitated insertion, but the stiffness of the distal tip limited the flexibility of the scope, especially when attempting J‐ or U‐turn views. Conclusion: Electronic radial ECDUS provides color flow images similar in quality to those of convex‐type ECDUS with the additional advantages of forward‐view optics and extended 270° views.     

Usefulness of electronic radial endoscopic color Doppler ultrasonography in esophageal varices: comparison with convex type

Background Endoscopic color Doppler ultrasonography (ECDUS) is a method for detecting color flow images in blood vessels. We previously reported on the usefulness of ECDUS (convex-type scanning instruments with forward—oblique viewing) for evaluating the hemodynamics of esophageal varices. In the present study, we report the usefulness of new electronic radial ECDUS in cases of esophageal varices by comparison with convex-type ECDUS. Methods Twenty-six patients with esophageal varices were identified and studied. The underlying pathologies of portal hypertension included liver cirrhosis (15 patients) and cirrhosis associated with hepatocellular carcinoma (11 patients). Endoscopic findings of esophageal varices were as follows: Cb, F3, and Ls varices in four patients; Cb, F2, and Lm varices in 21 patients; and Cb, Lm, and F1 varices in one patient. RC₁ was observed in the esophagus in 14 of the 26 patients. RC₂ was noted in 11 cases, and RC₀ was seen in one patient. ECDUS was performed using a Pentax EG-3630UR (forward view) with a distal tip diameter of 12 mm. The instrument (electronic radial array) has a curved array scanning transducer with variable frequency (5.0, 7.5, 10.0 MHz). A Hitachi EUB 6500,8500 was used for the display, providing 270° images. We monitored the color flow images of esophageal varices, paraesophageal veins, palisade veins, perforating veins, and pulsatile waves using this technique. As a control, 110 patients were examined by convex-type ECDUS. Results (1) Color flow images of esophageal varices and paraesophageal veins were obtained in 26 of the 26 patients, whereas color flow images of perforating veins were obtained in 18 of the 26 patients (69.2%). Color flow images of palisade veins were obtained in 12 of the 26 patients (46.2%). (2) Color flow images of pulsatile waves were obtained in 10 of the 26 patients (38.5%). Color flow images of pulsatile waves were detected in zero (0%) of the 4 F3 varices, in nine (42.9%) of the 21 F2 varices, and in the 1 (100%) case of F1 varices. Also, color flow images of pulsatile waves were detected in seven (50.0%) of the 14 RC₁ varices, in two (18.2%) of the 11 RC₂ varices, and in the 1 (100%) case of RC₀ varices. (3) As a control, 110 patients were examined by convex-type ECDUS. Color flow images of esophageal varices and paraesophageal veins were obtained in 110 of the 110 patients, whereas color flow images of perforating veins were obtained in 74 of 110 (67.3%) with convex-type ECDUS. The detection rate of palisade veins with electronic radial ECDUS (12 of the 26 patients, 46.2%) was significantly higher than with convex-type ECDUS (28 of the 110 patients, 25.5%) (P < 0.05). The detection rate of pulsatile waves with electronic radial ECDUS (10 of the 26 cases, 38.5%) was significantly higher than with convex-type ECDUS (3 of the 110 cases, 2.7%) (P < 0.0001). Conclusions Electronic radial ECDUS provides clear color flow images of blood vessels in esophageal varices with the additional advantages of forward-view optics and extended 270° views. Electronic radial ECDUS was superior to convex-type ECDUS in detecting palisade veins and pulsatile waves.     

Hemodynamic evaluation of rectal varices by endoscopic color Doppler ultrasonography

Background: Rectal varices are an infrequent but potentially serious cause of hematochezia. In this paper, the hemodynamics of rectal varices using endoscopic color Doppler ultrasonography (ECDUS) are evaluated. Method: This study consisted of six rectal variceal patients who had F2 type of the rectum, and four of the six had a positive red color sign. We monitored the color flow images of rectal varices. Results: Color flow images of rectal varices were obtained in all six patients. Color flow images of inflow and outflow vessels of rectal varices were obtained in all six patients. We performed endoscopic injection sclerotherapy (EIS) on three of the six patients. After EIS, ECDUS revealed the disappearance of the variceal blood flow in one case, and the decrease of blood flow in two cases. Conclusion: The technique of ECDUS is a useful modality for detecting rectal varices on color flow images and for evaluating the therapeutic effects of EIS.     

Value of endoscopic color doppler ultrasonography in endoscopic injection sclerotherapy‐resistant esophageal varices

A 72‐year‐old man with type C cirrhosis was admitted to our hospital for refractory esophageal varices. Prophylactic endoscopic injection sclerotherapy (EIS) was performed twice in August 2000 for high‐risk esophageal varices at an outside hospital. However, a therapeutic effect was not attained. Endoscopic ?nding revealed F1, Cb, RC (–) at the gastroesophageal junction to approximately a 5‐cm oral site, and F3, Cb, RC (+) varices at the upper site from the 5‐cm oral site of the gastroesophageal junction. Color ?ow images were obtained of the posterior branch of the left gastric vein and revealed an in?ow‐type perforating vein about a site 5 cm oral from the gastroesophageal junction. Color ?ow images of esophageal varices were detected with endoscopic color Doppler ultrasonography. Color ?ow images of out‐?owing‐type perforating veins were discerned in the middle esophagus. The vessel images of intramural esophageal varices were clearly delineated via an ultrasonic microprobe and showed a perforating vein with a diameter of 4 mm. We performed EIS with an attached balloon to occlude the out‐?owing‐type perforating veins with 5% ethanolamine oleate with iopamidol. Seven days after the ?rst EIS, thromboses were observed in the intramural esophageal varices and in the in?ow type‐perforating veins via ultrasonic microprobe. We exchanged the hemodynamics of this esophageal variceal case with blockade of the in?ow‐type perforating vein. Next, we successfully performed EIS, and achieved the blockade of passageways, including the palisade veins. Forty days after EIS, endoscopic ?ndings revealed disappearance of the esophageal varices.     

Evaluation of the alternate blood FLow in esophageal variceal patients by endoscopic color Doppler ultrasonography

Background: Endoscopic color Doppler ultrasonography (ECDUS) is a useful modality for obtaining color ?ow images of esophageal varices. The direction of blood ?ow in passageways is fundamentally hepatofugal ?ow according to ECDUS. The present study is designed to evaluate the alternate direction of color ?ow image of passageways via ECDUS in esophageal variceal patients. Methods: The study involved 125 patients with esophageal varices using ECDUS. The grades of red color (RC) were as follows: RC(+) in 79 cases, RC(+ +) in 35 cases, and RC(+ + +) in 11 cases. We investigated the alternate direction on color ?ow images of the left gastric vein, the palisade vein, and the perforating veins via ECDUS. Results: Color ?ow images of the esophageal varices and the left gastric vein were obtained in all 125 (100%) patients by ECDUS. Color ?ow images of the perforating veins were obtained in 90 (72.0%) of the 125 patients. Vessel images of the palisade veins were detected in 33 (26.4%) of the 125 patients. The alternate direction on color ?ow images was detected in seven (5.6%) of the 125 patients with ECDUS: in three patients, left gastric vein; in three patients, perforating veins; and in one patients, left gastric vein and palisade veins. This phenomenon was observed periodically at regular intervals. The endoscopic ?ndings were RC(+) in all seven patients. Conclusion: The alternate direction of blood ?ow in the passageways was observed in a few cases of RC(+) esophageal varices. We can observe the hemodynamics of esophageal varices non‐invasively and in real time with ECDUS, and clarify the frequencies of the alternate direction of blood ?ow in RC‐positive esophageal variceal patients.     

Color Doppler endoscopic ultrasonography in identifying groups at a high-risk of recurrence of esophageal varices after endoscopic treatment

BACKGROUND: Our preliminary study indicated that either a high hepatofugal flow velocity in the left gastric vein (LGV) or an anterior branch dominant pattern seen under color Doppler EUS (CD-EUS) were possible contributing risk factors for variceal recurrence after endoscopic treatment. However, the sample size was too small, and in this study we aimed to validate the results of the preliminary study. METHODS: Sixty-eight patients treated for moderate or large esophageal varices between 2001 and 2004 at a single university hospital were enrolled in this study. CD-EUS was followed by endoscopic variceal ligation and sclerotherapy. RESULTS: Patients were classified into either a high-risk group, which exhibited anterior branch dominance and flow velocity of 12 cm/s or more, or a low-risk group, which included all other patients. Half of the patients in the high-risk group exhibited a recurrence within half a year, whereas it took almost 2 years for half of the patients in the other group to exhibit a recurrence (P=0.0044). Using the Cox proportional hazard model with multivariate analysis, only the features of the high-risk group were significant in triggering recurrence of varices (hazard ratio [HR], 3.00; 95% confidence interval [CI], 1.35-6.65; P<0.001). CONCLUSIONS: These results suggest that patients showing anterior branch dominance and rapid hepatofugal flow velocity in the LGV on CD-EUS examination may have a high risk of an early recurrence of esophageal varices.     

Evaluation of solitary and scattered esophageal varices according to infrared endoscopy and endoscopic ultrasonography

BACKGROUND AND AIM: The aim of this study was to clarify the etiology and clinical significance of solitary and scattered esophageal varices by evaluating their hemodynamics and other characteristics using infrared endoscopy and endoscopic ultrasonography. METHODS: The study group comprised 44 lesions of these two related types detected in 28 patients by visible-light endoscopy. Infrared endoscopy was used to characterize blue-black coloration before and after rapid intravenous injection of indocyanine green (2 mg/kg). During endoscopic ultrasonography, depth within the esophagus and echo patterns of these varices were characterized. RESULTS: Diameters of these varices were significantly smaller in lesions more strongly staining by infrared endoscopy. Lesion diameter was significantly smaller in varices showing homogeneous low echogenicity than in those showing mixed echogenicity. Lesions showing homogeneous high echogenicity stained most weakly followed in turn by lesions with mixed echogenicity and finally those showing homogeneous low echogenicity. CONCLUSION: Indocyanine green injection was useful for infrared observation of the hemodynamics of solitary and scattered esophageal varices, as was endoscopic ultrasonography in defining the location and morphology of these lesions. Varices with larger diameters stained more persistently when hemodynamics were evaluated by infrared endoscopy, and often showed a mixture of low and high echogenicity by endoscopic ultrasonography. These observations suggest that blood flow in the varices is slowed, and that the risk of hemorrhage increases with increased diameter especially with uniform enhancement and uniform echogenicity.     

Evaluation of hemodynamics in esophageal varices: Value of endoscopic color Doppler ultrasonography with a galactose-based contrast agent

Endoscopic color Doppler ultrasonography (ECDUS) is a useful modality for obtaining color flow images of esophageal varices. Levovist is a microbubble echo-enhancing agent, which improves Doppler ultrasound examination. In this paper, we compared vessel images detected with pre-contrast with those detected by enhanced ECDUS using Levovist in 62 patients with esophageal varices. Color flow images of esophageal varices and paraesophageal veins by pre-contrast ECDUS were obtained in 62 (100%) of the 62 patients. Vessel images of perforating veins were obtained in 48 (77.4%) of the 62 patients with pre-contrast ECDUS. The perforating veins were classified into three types according to the flow direction. Type 1 showed in-flow from the paraesophageal veins to the esophageal varices, Type 2 showed out-flow from the esophageal varices to the paraesophageal veins, and Type 3 was a mixed type showing both in-flow and out-flow. After Levovist contrast, color flow images detected with pre-contrast ECDUS were improved in all patients. Color flow images of perforating veins were obtained in 60 (96.8%) of the 62 patients by enhanced ECDUS using Levovist. Pre-contrast-diagnosed Type 2 patterns had been re-diagnosed as Type 3 in five patients, and three cases with Type 1 had been relabeled as Type 3 pattern using Levovist. The use of Levovist contrast can improve the diagnostic quality of ECDUS examinations of esophageal variceal patients, yielding a much clearer picture of the hemodynamics.     

Evaluation of esophageal varices using contrast-enhanced coded harmonic ultrasonography

AIM: To investigate if esophageal varices can be evaluated using external contrast-enhanced ultrasonography with Levovist and coded harmonic angio (CHA). METHODS: Subjects were six healthy adult volunteers and 23 patients with liver cirrhosis. After identification of the lower esophagus under B-mode scanning, 300 mg/mL of Levovist was intravenously injected into the cubital vein at a rate of 1 mL/s under observation by CHA-mode scanning. Approximately 30 s after intravenous administration, interval-delay scanning was performed every second to visualize the area around the lower esophageal lumen. The degree of ultrasonographic enhancement was assessed as either no enhancement (negative); linear enhancement along the esophageal wall (weak) or full enhancement of the esophageal lumen (strong). Endoscopic evaluation of esophageal varices was also performed. RESULTS: The CHA enhancement around the lower esophageal lumen was identified in 21 of the 23 patients. Of these 21 patients, endoscopic assessments of varices were as follows: F0 in four patients, F1 in seven patients, F2 in three patients, and F3 in seven patients. Nine patients were red color sign (RCS)-positive. Regarding the relationship between ultrasonographic enhancement and endoscopic assessment, enhancement was identified as negative in all four F0 patients, negative in three and weak in three and strong in one of the seven F1 patients, weak in one and strong in two of the three F2 patients, and weak in two and strong in five of the seven F3 patients, respectively. Furthermore, of the nine RCS-positive patients, enhancement was recognized as strong in seven and weak in two patients. Ultrasonographic enhancement was identified as negative in all six healthy volunteers. CONCLUSIONS: By performing contrast-enhanced CHA ultrasonography using Levovist, ultrasonographic enhancement was detectable in all patients with varices categorized as F2 or above. Because the present method is easy to perform and causes less pain to patients compared to endoscopy, it is useful for following and assessing esophageal varices in patients with liver cirrhosis.     

Evaluation of therapeutic effects on rectal varices using percutaneous color Doppler ultrasonography

Aim:  We report the usefulness of percutaneous color Doppler ultrasonography (CDU) for evaluating therapeutic effects on rectal varices.
Methods:  Ultrasonographic examination and color flow imaging were performed using a color Doppler unit (Aplio 50 or XV, Toshiba, Tokyo, Japan) with a 3.5 MHz convex probe. We performed endoscopic injection sclerotherapy (EIS) for rectal varices in seven patients and partial splenic arterial embolization (PSE) for hypersplenism in four. We examined color flow images and measured the velocity of blood flow in rectal varices using fast-Fourier transform analysis by CDU in all eleven patients, before and after treatments.
Results:  Rectal varices were detected by Doppler color flow imaging in all eleven patients before treatments. Blood flowvelocity in the rectal varices ranged from 5.7–11.6 cm/s (mean 8.6 cm/s). Rectal varices were observed in all patients by colonoscopy; enlarged, tortuous large varices with red color sign in nine and enlarged, tortuous large varices without red color in two. Seven days after EIS or PSE, CDU showed an extreme decrease in blood flow in all eleven rectal varices, compared to values before EIS or PSE.
Conclusions:  CDU can be performed repeatedly and is useful for evaluating the therapeutic effects of treatments for rectal varices.     

Evaluation of the hemodynamics of rectal varices by endoscopic ultrasonography

Background The usefulness of endoscopic color Doppler ultrasonography (ECDUS) for evaluating hemodynamics is examined in 12 cases of rectal varices. We also evaluate the safety of endoscopic therapies in rectal variceal patients. Methods ECDUS was performed for 12 rectal variceal patients with a 7.5-MHz convex-type Pentax FG-32UA system. A Hitachi EUB 525 was used for the display. ECDUS provides a color display of blood flow, and calculates the velocity using a fast-Fourier transform analysis. We monitored the color flow images and measured blood flow velocity in rectal varices. Then, we evaluated the velocity of 350 F2-type esophageal varices via ECDUS, and compared the velocities between rectal varices and esophageal varices. Results Color flow images of rectal varices and of inflow vessels to rectal varices were obtained in all 12 patients with ECDUS. The mean velocity of F2-type rectal varices was 5.5 ± 1.3 cm/s (n = 12), while the mean velocity of F2 esophageal varices was 8.4 ± 3.1 cm/s (range, 4.5–12.5 cm/s) (n = 350) via ECDUS. The velocities in rectal varices were lower than those in esophageal varices. Endoscopic injection sclerotherapy (EIS) was successfully performed in five red-color-sign-positive rectal variceal patients having a mean velocity 5.4 ± 1.1 cm/s. Conclusions The velocities of rectal varices were lower than those of esophageal varices. Evaluation of the hemodynamics of rectal varices is important for determining the appropriate therapeutic option. EIS is an effective therapy in cases of slow variceal flow. ECDUS is a necessary tool for effective and safe EIS for rectal varices.     

Hemodynamics of esophageal varices on three‐dimensional endoscopic ultrasonography and indication of endoscopic variceal ligation

Background: Esophageal varices are treated by endoscopic variceal ligation or sclerotherapy, but the indications for each procedure are not standardized. The present study was designed to determine the indication of endoscopic variceal ligation based on vascular pattern classified by 3‐dimensional endoscopic ultrasonography (3‐D‐EUS). Methods: The pattern of variceal blood flow detected on 3‐D images was classified into type 1 (cardial‐inflow without paraesophageal veins), type 2 (cardial‐inflow with paraesophageal veins), type 3 (azygos‐perforating pattern) and type 4 (complex pattern). 3‐D‐EUS was performed in 89 patients with esophageal varices. Subsequently, ligation was performed in 44 patients, while sclerotherapy with 5% ethanolamine oleate was applied in 45 patients in a prospective randomized trial. Clinical outcome was assessed. Results: Based on the 3‐D‐EUS data, 41 patients (46.1%) were classified as type 1, 12 (13.5%) as type 2, seven (7.9%) as type 3 and 29 patients (32.6%) as type 4. The cumulative recurrence‐free probability at 24 months after treatment was 28.9% for ligation versus 71.1% for sclerotherapy (P < 0.05) in type 1, while the respective probabilities were 72.9% versus 50.0% (NS) for type 2 varices, 100% versus 100% (NS) for type 3 varices and 61.9% versus 64.8% (NS) for type 4 varices. Conclusions: Classification of the vascular pattern of esophageal varices by 3‐D‐EUS enabled us to clarify the criteria for selection of endoscopic procedure. Ligation is indicated for patients who have collaterals, such as paraesophageal veins running parallel to the varices, as the blood flow can be diverted to these blood vessels and controlled by localized ligation.     

Pancreatic cancer evaluated by contrast‐enhanced color doppler endoscopic ultrasonography

We performed contrast‐enhanced color Doppler endoscopic ultrasonography in a 78‐year‐old patient with pancreatic cancer. Extracorporeal ultrasound demonstrated dilatation of both the intra‐ and extrahepatic bile ducts; however, the cause of obstructive bile‐duct change was not clarified. Endoscopic ultrasonography was performed in the routine manner and demonstrated a small tumor in the head of the pancreas. Before Levovist administration, there were no color signals detected in either the tumor or the pancreatic parenchyma. After administration of the agent, color signals began to emerge only in the pancreatic parenchyma surrounding the cancer tumor. There was still a lack of color signals inside the tumor. It is suggested that detailed hemodynamic changes that were not apparent by the conventional method could be identified by the contrast method under endoscopic ultrasonography.     

超声内镜在食管胃底静脉曲张治疗及预后评估中的作用

超声内镜(EUS)通过全面评估门静脉高压侧支循环建立情况,既可预测评估食管胃底静脉曲张首次出血、治疗后复发及再出血的风险,又可引导并参与静脉曲张的治疗。介绍了EUS在食管胃底静脉曲张治疗及预后评估中的独特优势,为肝硬化合并食管胃底静脉曲张患者的个体化治疗提供了重要参考依据,并且提高了治疗的安全性和有效率,通过EUS系统诊治门静脉高压症已成为近几年的研究热点。     

二维及彩色多普勒超声观察胃十二指肠动脉血流动力学参数

目的 :初步评估超声检测胃十二指肠动脉 （GDA ）、肝总动脉 （CHA ）的显示率与正常值范围 ,观察进食前后GDA、CHA血流参数的变化。方法 :应用二维及彩色多普勒超声分别测量 30例正常成人空腹和服用 2 5 0 g/ L葡萄糖 2 0 0 ml后 4 0 m in测 GDA、CHA的血流动力学参数的变化。结果 :正常成人 GDA二维超声与彩色多普勒显像的显示率分别为 91%和 96 % ,餐后 GDA、CHA血管内径、血流速度和血流量高于餐前 ,PI、RI变化不显著。结论 :掌握 GDA、CHA的检查方法及正常值范围对临床有重要意义 ,进餐对 GDA、CHA血流参数有显著影响。     

Echo contrast agents improve flow display of color Doppler: in vitro studies

Flow detection by color Doppler is impaired by low velocity of flow and increasing attenuation and depth of ultrasound penetration. The effects of increased echogenicity on flow detection (Toshiba SSH 65A) were thus studied in a flow model, which yielded similar strengths of Doppler signals as seen in the clinical routine, by adding microbubble solutions to the blood analog fluid (45% aqueous glycerin) and comparing signal strength (score 0-5) prior to and after contrast. The flow within the plexiglass tube with less than 3 degrees angle of coincidence for Doppler interrogation was laminar with a parabolic velocity profile at physiological velocities and pressures. In comparison with various contrast agents at a flow velocity of 18 cm/sec and 19 dB attenuation, flow was not detectable in control color Doppler, after 4 mL of the blood analog fluid, and after 4 mL of an agitated saline solution 9 mg/mL, but visible after 4 mL of Echovist, a polysaccharide solution with reproducible bubble size and concentration and after 4 mL of an agitated polygelatin solution. Increasing concentration of Echovist (50-400 mg/mL) improved flow detection. Echovist 200 mg/mL enhanced the score by 1.1 + -0.6 for velocities 5-20 cm/sec (P less than 0.01), by 1.6 + -0.8 for 40-100 cm/sec (P less than 0.001), and by 1.1 + -0.6 for velocities greater than 150 cm/sec (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Successful endoscopic therapy of superficial esophageal cancer on varices in a patient with alcoholic liver cirrhosis

A case of successful endoscopic therapy of superficial esophageal cancer on varices in a patient with alcoholic liver cirrhosis is reported. A slightly depressed superficial cancer (type 0‐IIc) occupied half the inner surface of the middle esophagus. Endoscopic ultrasonography revealed esophageal varices and periesophageal collaterals, but no perforating veins connecting the varices and collaterals were observed where the cancer was located. The esophageal cancer could not be detected even with a 20 MHz microprobe. The tortuous esophageal varices in the lower esophagus were endoscopically ligated to reduce blood flow just below the cancer and 10 mL polidocanol solution was endoscopically injected to induce sclerosis of the varices. After these procedures, the mucosal cancer was endoscopically resected without any severe complications and residual cancer was eliminated by cauterization using a heater probe. Histopathological examination revealed that poorly differentiated squamous cell carcinoma invaded into the lamina propria mucosae but not into the vessels or the lymphatic system. Three years after treatment, the patient showed no signs of local recurrence of cancer. It is considered that the endoscopic techniques used in this patient constitute a valuable and minimally invasive treatment for superficial esophageal cancer on varices.     

Clinical and endoscopic features of gastric varices secondary to splenic vein occlusion

Aim: This study provides a retrospective evaluation of cases with gastric varices secondary to splenic vein occlusion. Methods: Our study group consisted of 14 patients. The clinical manifestations, diagnostic methods and therapeutic modalities were analyzed retrospectively. Results: Eleven patients had co‐existing pancreatic diseases: seven with chronic pancreatitis, three with cancer of the pancreatic body or tail and one with severe acute pancreatitis. Among the three remaining patients, one had advanced left renal cancer, one had myeloproliferative disease and the third had splenic vein occlusion due to an obscure cause. A diagnosis of gastric varices was made following endoscope gastroduodenoscopy or endoscopic color Doppler ultrasonography (ECDUS), and splenic vein occlusions were diagnosed from enhanced computed tomography in all cases. Specific findings of gastric varices secondary to splenic vein occlusion were based on ECDUS color flow images of gastric variceal flow that clearly depicted round cardiac and fundal regions at the center, with varices expanding to the curvatura ventriculi major of the gastric body. For three cases with gastric variceal bleeding, endoscopic injection sclerotherapy using a mixture of histoacryl and lipiodol (70% histoacryl solution) was performed, after which no further bleeding from gastric varices was detected. Due to a high risk of gastric variceal rupture, splenectomy was performed in two cases and splenic arterial embolization in another two cases. Conclusion: ECDUS color flow images of gastric variceal flow depicted specific findings of gastric varices secondary to splenic vein occlusion. Treatment should take into account the diseases underlying these conditions.