Utility of endoscopic ultrasound in the diagnosis and management of esophagogastric varices

An-Jiang Wang, Bi-Min Li, Xue-Lian Zheng, Xu Shu, Xuan Zhu, An-Jiang Wang, Bi-Min Li, Xue-Lian Zheng, Xu Shu, Xuan Zhu

Abstract

Endoscopic ultrasound (EUS) has significantly improved our understanding of the complex vascular structural changes in patients with portal hypertension. At present, EUS is a useful diagnostic tool for the evaluation of esophagogastric varices (EGVs) and guidance of endoscopic therapy. Several studies have employed this new technique for the diagnosis and management of esophageal and gastric varices, respectively. In the present review, we have summarized the current status of EUS for the diagnosis and management of EGVs and clarified the clinical feasibility of this procedure. New indications for EUS can be developed in the future after adequate validation.

Figures

Figure 1
Figure 1
Endoscopic ultrasound-guided sclerotherapy. (a) Endoscopic ultrasound image showing esophageal collateral vessels (arrows); (b) endoscopic ultrasound-guided sclerotherapy for esophageal varices (arrows indicate needle location) (reprinted with permission from Elsevier)
Figure 2
Figure 2
Endoscopic views (a) gastric varices with stigmata of recent bleeding (arrow) by using the forward-view curved linear array endoscopic ultrasound; (b) coil and glue extrusion (arrow) 1 month after treatment; (c) eradication of gastric varices (arrow) 3 months after treatment (reprinted reference with permission from Elsevier)
Figure 3
Figure 3
Endoscopic ultrasound-guided treatment of gastric varices with combined coiling and glue injection. (a) Transesophageal endoscopic ultrasound views (forward-view curved linear array endoscopic ultrasound) showing gastric varices targeted with a 19 gauge needle (arrow), (b) deployment of coil (arrows) through the 19 gauge needle, (c) injection of 1 mL glue through the 19 gauge needle to obliterate the gastric varice, and (d) eradication of gastric varices (conventional curved-linear endoscopic ultrasound). C: Crus muscle; F: Gastric fundus; MP: Muscularis propria of the gastric wall (reprinted from with permission from Elsevier)
Figure 4
Figure 4
Endoscopic ultrasound and fluoroscopic view of endoscopic ultrasound-guided transjugular intrahepatic portosystemic shunt. (a) The stent (one arrow) is advanced over the guidewire (two arrows) into the HV (three arrows) and (b) deployment of the stent started from its distal end. The stent was inside the HV (one arrow) and the PV (two arrows), (c) the stent was fully deployed inside the HV (one arrow) and the PV (two arrows) over the guidewire (three arrows), (d) fluoroscopic view showing the stent was fully deployed, (e) endoscopic ultrasound with color Doppler demonstrating blood flow through the fully deployed stent (one arrow), (f) fluoroscopy demonstrated the flow of contrast injected into the PV (one arrow) through the stent (two arrows) and into the HV (three arrows) (reprinted with permission from Elsevier)

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