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Evaluation of Patients with Esophageal Varices After Endoscopic Injection Sclerotherapy Using Multiplanar Reconstruction MDCT Images

¹ Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
² Department of Radiology, Division of Medical Intelligence and Informatics, Programs for Applied Biomedicine, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan.

OBJECTIVE. The purpose of our study was to assess the relationship between hemodynamic changes in portosystemic collaterals and the prognosis of patients with esophageal varices after endoscopic injection sclerotherapy using multiplanar reconstruction (MPR) MDCT images.

SUBJECTS AND METHODS. The subjects of this prospective study were 53 patients who underwent endoscopic injection sclerotherapy for esophageal varices. We evaluated the reconstructed MPR images of portosystemic collaterals before and after endoscopic injection sclerotherapy. Patients were divided into three groups based on the rate of change in the diameter of the feeding vessel into complete eradication (group A), narrowing (group B), and no change (group C). We analyzed the relationship between hemodynamic change in portosystemic collaterals and prognosis.

RESULTS. The left gastric vein, posterior gastric vein, and left gastric vein plus posterior gastric vein were the main feeding vessels (n = 44 [83%] of patients, n = 5 [9%], and n = 4 [8%], respectively). The proportions of patients of groups A, B, and C were 19% (n = 10), 24% (n = 13), and 57% (n = 30), respectively. The relapse-free rates at 2 years after endoscopic injection sclerotherapy were 100%, 65%, and 52% in groups A, B, and C, respectively (p < 0.05). For group C, the relapse-free rate at 2 years after endoscopic injection sclerotherapy of patients with a large-diameter paraesophageal vein ( 3 mm, 63%) was significantly higher than in those with a small-diameter paraesophageal vein (< 3 mm, 36%; p < 0.05). However, there were no significant differences in the survival rate among the three groups.

CONCLUSION. MPR MDCT images on portosystemic collaterals can accurately predict relapse of esophageal varices after endoscopic injection sclerotherapy.

Keywords: endoscopic injection sclerotherapy • esophageal varices • multiplanar reconstruction image • portosystemic collaterals • recurrence

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