Portal Hypertension & Cirrhosis (Jun 2022)
Impact of endoscopic ultrasound examination for deep esophageal collateral veins evaluation in liver cirrhosis patients prior to endoscopic treatment: A case series
Abstract
Abstract Aim The presence of esophageal collateral veins (ECV) has been reported to be associated with the recurrence of esophageal varices (EV) and bleeding in liver cirrhotic (LC) patients. This study aimed to see the potential clinical value of deep collateral veins assessment using endoscopic ultrasound (EUS) in liver cirrhotic patients with EV. Methods During 6 months period, a prospective study is conducted, where we identified LC patients who were admitted for esophagogastroduodenoscopy (EGD) screening at the Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Jakarta. ECV was examined using EUS. Patients were excluded if they had (1) liver malignancy, (2) history of ligation or glue injection, or (3) portal or splenic vein thrombus. We collected demographic data, medical history, data pertaining to use of nonselective beta blocker (NSBB), and laboratory, imaging, and endoscopy results. EGD was performed using a gastroscope (EG29‐i10, 3.2 mm Pentax Medical) while EUS was performed using a linear array echoendoscope (EG‐3870UTK, 3.8 mm, Pentax Medical) before band ligation or glue injection. Results There were 20 LC patients included in this study, where 15 (75%) of patients were classified with Child–Pugh (CP)‐A and five (25%) of patients with CP‐B. The most common aetiologies were hepatitis B in seven (35%) patients and hepatitis C in nine (45%) patients. The EV with peri‐ or para‐esophageal veins (PEEV or PAEV) were detected in 65% of patients. None of the LC patients with no EV showed the presence of ECV. PEEV or PAEV were detected in grades 1–3 EV. Conclusion EUS examination can give a better evaluation before managing gastroesophageal varices through deep ECV detection in LC patients.
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