Endoscopic ultrasonography (EUS) has significantly improved our understanding of the
complex vascular structural changes that occur in portal hypertension and their clinical
and prognostic significance. EUS in combination with color Doppler technique enables
us to study the hemodynamic changes in the portal venous system noninvasively, and
to determine objectively the effect of different pharmacological agents on portal
hypertension. EUS has also found some role in the treatment and follow up of esophageal
and gastric varices. It may play a clinical role in the diagnosis of gastric, duodenal,
and rectal varices. Recently reported EUS-based devices that measure variceal wall
tension and intravariceal pressure noninvasively could have an impact on the identification
of patients at high risk of variceal bleeding with the aim of initiating prophylactic
treatment, and in the assessment of patients’ responses to drug therapy of portal
hypertension. EUS is occasionally very helpful in the clinical management of portal
hypertension. It is an interesting and important research tool for many experimental
indications that are not routinely applied in clinical practice at this time.
- 1
McCormack T, Martin T, Smallwood R H. et al .
Doppler ultrasound probe for assessment of blood-flow in oesophageal varices.
Lancet.
1983;
1
677-678
- 2
Caletti G C, Bolondi L, Zani L. et al .
Detection of portal hypertension and esophageal varices by means of endoscopic ultrasonography.
Scand J Gastroenterol Suppl.
1986;
123
74-77
- 3
Hashizume M, Kitano S, Sugimachi K, Sueishi K.
Three-dimensional view of the vascular structure of the lower esophagus in clinical
portal hypertension.
Hepatology.
1988;
8
1482-1487
- 4
Kitano S, Terblanche J, Kahn D, Bornman P C.
Venous anatomy of the lower oesophagus in portal hypertension: practical implications.
Br J Surg.
1986;
73
525-531
- 5
Rösch T.
Endoscopic ultrasonography.
Endoscopy.
1992;
24
144-153
- 6
Kimmey M B, Martin R W, Haggitt R C. et al .
Histologic correlates of gastrointestinal ultrasound images.
Gastroenterology.
1989;
96
433-441
- 7
Caletti G, Brocchi E, Baraldini M. et al .
Assessment of portal hypertension by endoscopic ultrasonography.
Gastrointest Endosc.
1990;
36
S21-S27
- 8
Burtin P, Cales P, Oberti F. et al .
Endoscopic ultrasonographic signs of portal hypertension in cirrhosis.
Gastrointest Endosc.
1996;
44
257-261
- 9
Choudhuri G, Dhiman R K, Agarwal D K.
Endosonographic evaluation of the venous anatomy around the gastro-esophageal junction
in patients with portal hypertension.
Hepatogastroenterology.
1996;
43
1250-1255
- 10
Liu J B, Miller L S, Feld R I. et al .
Gastric and esophageal varices: 20-MHz transnasal endoluminal US.
Radiology.
1993;
187
363-366
- 11
Nishizono M, Haraguchi Y, Eto T. et al .
Endoscopic ultrasonography using a 15/20 MHz probe in a direct contact technique:
evaluation and application in esophageal and gastric varices.
Fukuoka Igaku Zasshi.
1994;
85
251-255
- 12
Miller L S, Schiano T D, Adrain A. et al .
Comparison of high-resolution endoluminal sonography to video endoscopy in the detection
and evaluation of esophageal varices.
Hepatology.
1996;
24
552-555
- 13
Suzuki T, Matsutani S, Umebara K. et al .
EUS changes predictive for recurrence of esophageal varices in patients treated by
combined endoscopic ligation and sclerotherapy.
Gastrointest Endosc.
2000;
52
611-617
- 14
Schiano T D, Adrain A L, Vega K J. et al .
High-resolution endoluminal sonography assessment of the hematocystic spots of esophageal
varices.
Gastrointest Endosc.
1999;
49
424-427
- 15
Iwase H, Suga S, Morise K. et al .
Color Doppler endoscopic ultrasonography for the evaluation of gastric varices and
endoscopic obliteration with cyanoacrylate glue.
Gastrointest Endosc.
1995;
41
150-154
- 16
Wong R C, Farooq F T, Chak A.
Endoscopic Doppler US probe for the diagnosis of gastric varices (with videos).
Gastrointest Endosc.
2007;
65
491-496
- 17
Watanabe K, Kimura K, Matsutani S. et al .
Portal hemodynamics in patients with gastric varices. A study in 230 patients with
esophageal and/or gastric varices using portal vein catheterization.
Gastroenterology.
1988;
95
434-440
- 18
Konishi Y, Nakamura T, Kida H. et al .
Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures
to predict esophageal variceal recurrence.
Gastrointest Endosc.
2002;
55
197-203
- 19
Lo G H, Lai K H, Cheng J S. et al .
Prevalence of paraesophageal varices and gastric varices in patients achieving variceal
obliteration by banding ligation and by injection sclerotherapy.
Gastrointest Endosc.
1999;
49
428-436
- 20
Pontes J M, Leitao M C, Portela F A. et al .
Endoscopic ultrasonography in the treatment of oesophageal varices by endoscopic sclerotherapy
and band ligation: do we need it?.
Eur J Gastroenterol Hepatol.
1995;
7
41-46
- 21
Irisawa A, Obara K, Sato Y. et al .
EUS analysis of collateral veins inside and outside the esophageal wall in portal
hypertension.
Gastrointest Endosc.
1999;
50
374-380
- 22
Nakamura H, Endo M, Shimojuu K. et al .
Esophageal varices evaluated by endoscopic ultrasonography: observation of collateral
circulation during non-shunting operations.
Surg Endosc.
1990;
4
69-74; discussion 75
- 23
Leung V K, Sung J J, Ahuja A T. et al .
Large paraesophageal varices on endosonography predict recurrence of esophageal varices
and rebleeding.
Gastroenterology.
1997;
112
1811-1816
- 24
Faigel D O, Rosen H R, Sasaki A. et al .
EUS in cirrhotic patients with and without prior variceal hemorrhage in comparison
with noncirrhotic control subjects.
Gastrointest Endosc.
2000;
52
455-462
- 25
McCormack T T, Rose J D, Smith P M. et al .
Perforating veins and blood flow in oesophageal varices.
Lancet.
1983;
2
1442-1444
- 26
Sukigara M, Komazaki T, Yamazaki T. et al .
Colour flow mapping of oesophagogastric varices and vessels in and around the liver
with trans-oesophageal real-time two-dimensional Doppler ultrasound.
Clin Radiol.
1987;
38
487-494
- 27
Hino S, Kakutani H, Ikeda K. et al .
Hemodynamic assessment of the left gastric vein in patients with esophageal varices
with color Doppler EUS: factors affecting development of esophageal varices.
Gastrointest Endosc.
2002;
55
512-517
- 28
Caletti G C, Brocchi E, Ferrari A. et al .
Value of endoscopic ultrasonography in the management of portal hypertension.
Endoscopy.
1992;
24 Suppl 1
342-346
- 29
Chen T K, Wu C H, Lee C L. et al .
Endoscopic ultrasonography in the differential diagnosis of giant gastric folds.
J Formos Med Assoc.
1999;
98
261-264
- 30
Avunduk C, Hampf F.
Endoscopic ultrasound in the diagnosis of watermelon stomach.
J Clin Gastroenterol.
1996;
22
104-106
- 31
Salama Z A, Kassem A M, Giovannini M, Hunter M S.
Endoscopic ultrasonographic study of the azygos vein in patients with varices.
Endoscopy.
1997;
29
748-750
- 32
Lee Y T, Sung J J, Yung M Y, Yu A L. et al .
Use of color Doppler EUS in assessing azygos blood flow for patients with portal hypertension.
Gastrointest Endosc.
1999;
50
47-52
- 33
Shin M S.
Clinical significance of azygos vein enlargement: radiographic recognition and etiologic
analysis.
Clin Imaging.
1999;
23
236-240
- 34
Hino S, Kakutani H, Ikeda K. et al .
Hemodynamic analysis of esophageal varices using color Doppler endoscopic ultrasonography
to predict recurrence after endoscopic treatment.
Endoscopy.
2001;
33
869-72
- 35
Kuramochi A, Imazu H, Kakutani H. et al .
Color Doppler endoscopic ultrasonography in identifying groups at a high-risk of recurrence
of esophageal varices after endoscopic treatment.
J Gastroenterol.
2007;
42
219-224
- 36
Parasher V K, Meroni E, Malesci A. et al .
Observation of thoracic duct morphology in portal hypertension by endoscopic ultrasound.
Gastrointest Endosc.
1998;
48
588-592
- 37
Goenka M K, Kochhar R, Nagi B, Mehta S K.
Rectosigmoid varices and other mucosal changes in patients with portal hypertension.
Am J Gastroenterol.
1991;
86
1185-1189
- 38
Dhiman R K, Saraswat V A, Choudhuri G. et al .
Endosonographic, endoscopic, and histologic evaluation of alterations in the rectal
venous system in patients with portal hypertension.
Gastrointest Endosc.
1999;
49
218-227
- 39
Lai L, Poneros J, Santilli J, Brugge W.
EUS-guided portal vein catheterization and pressure measurement in an animal model:
a pilot study of feasibility.
Gastrointest Endosc.
2004;
59
280-283
- 40
Johansen K, Paun M.
Duplex ultrasonography of the portal vein.
Surg Clin North Am.
1990;
70
181-190
- 41
Perisic-Savic M, Colovic R, Milosavljevic T, Ivanovic L.
Splenic vein thrombosis. Diagnosed with Doppler ultrasonography.
Hepatogastroenterology.
1991;
38
557-560
- 42
Wiersema M J, Chak A, Kopecky K K, Wiersema L M.
Duplex Doppler endosonography in the diagnosis of splenic vein, portal vein, and portosystemic
shunt thrombosis.
Gastrointest Endosc.
1995;
42
19-26
- 43
Bosch J, Mastai R, Kravetz D. et al .
Measurement of azygos venous blood flow in the evaluation of portal hypertension in
patients with cirrhosis. Clinical and haemodynamic correlations in 100 patients.
J Hepatol.
1985;
1
125-139
- 44
Hansen E F, Bendtsen F, Brinch K, Moller S. et al .
Endoscopic Doppler ultrasound for measurement of azygos blood flow. Validation against
thermodilution and assessment of pharmacological effects of terlipressin in portal
hypertension.
Scand J Gastroenterol.
2001;
36
318-325
- 45
Nishida H, Giostra E, Spahr L. et al .
Validation of color Doppler EUS for azygos blood flow measurement in patients with
cirrhosis: application to the acute hemodynamic effects of somatostatin, octreotide,
or placebo.
Gastrointest Endosc.
2001;
54
24-30
- 46
Kassem A M, Salama Z A, Zakaria M S. et al .
Endoscopic ultrasonographic study of the azygos vein before and after endoscopic obliteration
of esophagogastric varices by injection sclerotherapy.
Endoscopy.
2000;
32
630-634
- 47
Jackson F W, Adrain A L, Black M, Miller L S.
Calculation of esophageal variceal wall tension by direct sonographic and manometric
measurements.
Gastrointest Endosc.
1999;
50
247-251
- 48
Miller E S, Kim J K, Gandehok J. et al .
A new device for measuring esophageal variceal pressure.
Gastrointest Endosc.
2002;
56
284-291
- 49
Miller L S, Dai Q, Thomas A. et al .
A new ultrasound-guided esophageal variceal pressure-measuring device.
Am J Gastroenterol.
2004;
99
1267-1273
- 50
Dhiman R K, Choudhuri G, Saraswat V A. et al .
Role of paraoesophageal collaterals and perforating veins on outcome of endoscopic
sclerotherapy for oesophageal varices: an endosonographic study.
Gut.
1996;
38
759-764
- 51
Irisawa A, Saito A, Obara K. et al .
Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities:
severe periesophageal collateral veins and large perforating veins.
Gastrointest Endosc.
2001;
53
77-84
- 52
Nagamine N, Ueno N, Tomiyama T. et al .
A pilot study on modified endoscopic variceal ligation using endoscopic ultrasonography
with color Doppler function.
Am J Gastroenterol.
1998;
93
150-155
- 53
Van Stiegmann G, Goff J S.
Endoscopic esophageal varix ligation: preliminary clinical experience.
Gastrointest Endosc.
1988;
34
113-117
- 54
Lahoti S, Catalano M F, Alcocer E. et al .
Obliteration of esophageal varices using EUS-guided sclerotherapy with color Doppler.
Gastrointest Endosc.
2000;
51
331-333
- 55
de Paulo G A, Ardengh J C, Nakao F S, Ferrari A P.
Treatment of esophageal varices: a randomized controlled trial comparing endoscopic
sclerotherapy and EUS-guided sclerotherapy of esophageal collateral veins.
Gastrointest Endosc.
2006;
63
396-402; quiz 463
- 56
Hsieh J S, Jan C M, Lu C Y. et al .
Preoperative evaluation of endoscopic ultrasonography and portography in selecting
devascularization surgery for esophagogastric varices.
Am Surg.
2005;
71
439-444
- 57
Lee Y T, Chan F K, Ng E K. et al .
EUS-guided injection of cyanoacrylate for bleeding gastric varices.
Gastrointest Endosc.
2000;
52
168-174
- 58
Romero-Castro R, Pellicer-Bautista F J, Jimenez-Saenz M. et al .
EUS-guided injection of cyanoacrylate in perforating feeding veins in gastric varices:
results in 5 cases.
Gastrointest Endosc.
2007;
66
402-407
- 59
Hsieh J S, Wang W M, Perng D S. et al .
Modified devascularization surgery for isolated gastric varices assessed by endoscopic
ultrasonography.
Surg Endosc.
2004;
18
666-671
- 60
Wu C S, Chen C M, Chang K Y.
Endoscopic injection sclerotherapy of bleeding duodenal varices.
J Gastroenterol Hepatol.
1995;
10
481-483
- 61
Sung J Y, Chung S C, Leung H T. et al .
Duodenal varices in hepatocellular carcinoma.
Endoscopy.
1993;
25
194-196
- 62
Nardone G, Budillon G.
Treatment of duodenal varices by endoscopic sclerotherapy.
Gastrointest Endosc.
1991;
37
407-408
- 63
Yeh Y Y, Hou M C, Lin H C. et al .
Case report: successful obliteration of a bleeding duodenal varix using endoscopic
ligation.
J Gastroenterol Hepatol.
1998;
13
591-593
- 64
Braillon A, Cales P, Valla D. et al .
Influence of the degree of liver failure on systemic and splanchnic haemodynamics
and on response to propranolol in patients with cirrhosis.
Gut.
1986;
27
1204-1209
- 65
Chung C Y, McCray W H, Dhaliwal S. et al .
Three-dimensional esophageal varix model quantification of variceal volume by high-resolution
endoluminal US.
Gastrointest Endosc.
2000;
52
87-90
M. S. Bhutani, MD, FACG
Department of Gastroenterology, Hepatology and Nutrition, Unit 436
University of Texas
MD Anderson Cancer Center
Faculty Center
Room 10.2028
1515 Holcombe Blvd
Houston
TX 77030-4009
USA
Fax: +1-713-5634398
Email: Manoop.Bhutani@mdanderson.org
