Abstract
Using endoscopic ultrasonography (EUS) a large part of the portal venous system can
be visualized. In 40 patients with portal hypertension (PH) and in 48 control subjects
EUS displayed the azygos, splenic, mesenteric and portal veins in both groups. However,
esophageal and gastric varices, peri- esophageal and peri-gastric collateral veins
and submucosal gastric venules were displayed only in patients with PH. EUS was inferior
to endoscopy for detecting and grading esophageal varices (p < 0.0005), but superior
in the detection of varices in the fundus of the stomach (p < 0.0005). EUS cannot
be considered a reliable method for the study of esophageal varices: it has an overall
sensitivity of 50 %, does not permit flow measurements, and does not provide information
that could be used to estimate the risk of bleeding. EUS has been demonstrated to
be superior to endoscopy in the diagnosis of gastric varices. This finding is extremely
important for the optimal selection of treatment of patients with portal hypertension.
EUS can detect portal hypertensive gastropathy; thus inflammatory gastritis can be
more easily distinguished from congestive gastropathy and therapeutic decisions are
strongly influenced.
