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

• Published in: Journal of gastroenterology and hepatology 2007-12, Vol.22 (12), p.2064-2068
• Main Authors: Tsujigami, Koji, Okamura, Seisuke, Fukuda, Tamotsu, Ichikawa, Soichi, Nakasono, Masahiko, Okita, Yoshio, Muguruma, Naoki, Ito, Susumu
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Digestive system. Abdomen; endoscopic ultrasonography; Endoscopy; Endoscopy, Gastrointestinal - methods; Endosonography - methods; Esophageal and Gastric Varices - diagnostic imaging; Esophageal and Gastric Varices - pathology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Indocyanine Green; infrared endoscopy; Investigative techniques, diagnostic techniques (general aspects); Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; scattered esophageal varices; solitary esophageal varices
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/j.1440-1746.2006.04618.x

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.