Role of paraoesophageal collaterals and perforating veins on outcome of endoscopic sclerotherapy for oesophageal varices: an endosonographic study.

R K Dhiman, G Choudhuri, V A Saraswat, D K Agarwal, S R Naik

Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

BACKGROUND--Endoscopic sclerotherapy (EST) is an established method for controlling and preventing bleeding from oesophageal varices. However, oesophageal varices sclerose easily and require less sessions of EST in some patients while few fail to respond. This study therefore looked at changes in the vascular anatomy of the lower oesophagus and upper stomach that accompany successful sclerotherapy of oesophageal varices. METHODS--Endoscopic ultrasonography was performed in 50 patients with cirrhotic portal hypertension before (control, 20 patients) and after successful obliteration of varices with endoscopic sclerotherapy in a group of responders (EST-R, 20 patients) and in a group of non-responders (EST-NR, 10 patients). RESULTS--The median number and size of submucosal veins at the gastrooesophageal junction and in the lower oesophagus were significantly less in the EST-R group compared with control and EST-NR groups (p values between < 0.00001 and < 0.000001). Concomitantly, the number and size of paraoesophageal collaterals were significantly less in the EST-R group compared with the other two groups (p values between 0.02 and 0.00007). Perforating veins were identified in 14 (70%) patients in the control group, nine (90%) in the EST-NR group and in none in the EST-R group (p < 0.001 for both controls v EST-R and EST-R v EST-NR, and p = NS, control v EST-NR). CONCLUSION--Oesophageal variceal sclerosis is associated with significant reduction in the number and size of paraoesophageal collaterals and disappearance of perforating veins in the lower oesophagus.

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