Radial endosonography vs. oesophagogastroduodenoscopy in detecting oesophageal and gastric varices

Authors: I. Tozzi Di Angelo 1;  V. Procházka 1;  M. Holinka 1;  I. Novotný 2;  R. Brůha 3;  M. Dvořák 3;  I. Vinklerová 1;  J. Zapletalová 4;  J. Kysučan 5
Authors‘ workplace: II. interní klinika, FN Olomouc 1;  Interní hepato-gastroenterologická klinika, FN Brno 2;  IV. interní klinika, VFN v Praze 3;  Ústav lékařské biofyziky, UP Olomouc 4;  I. chirurgická klinika, FN Olomouc 5
Published in: Gastroent Hepatol 2011; 65(3): 133-140
Category: Hepatology: Original Article


The aims of the multicentric study were:
1. to assess the sensitivity of 12 and 20 MHz radial endosonography (rEUS) and oesophagogastroduodenoscopy (EGD) in the detection and size of gastric varices (GV) and oesophageal varices (OV); 2. to ascertain the relationship between liver function damage and variceal size; 3. to compare signs of portal hypertension provable in abdominal ultrasonography with endoscopic findings; 4. to evaluate the incidence and size of varices depending on blood flow through the portal vein by Doppler ultrasound. The procedures (endosonography, oesophago-gastroduodenoscopy, transabdominal ultrasonography and Doppler measurement in the portal and lienal veins, determination of liver function reserve) were done, on a blinded basis, by separate teams who were not informed about the results of individual investigations. The group comprised 61 patients suffering from liver cirrhosis with an average age of 54.5±10.5 (23–84). The sensitivity and specificity of rEUS related to EGD in the detection of OV was 94.4% and 71.4%, respectively. The concordance of EGD and rEUS in the detection of oesophageal and gastric varices was 91.8% and 60.6% of cases, respectively, in the localization of OV in 57.1% of cases and in the size of varices in 66%. A statistically significant relationship between the severity of liver disease according to the Child-Pugh classification and the size of OV determined by EGD and rEUS was identified (p=0.012 and p=0.006, respectively). Radial endosonography is capable of a precise diagnosis of the presence of oesophageal and gastric varices. It is a more reproducible method for measuring the size of varices.

Key words:
endosonography – gastrointestinal bleeding – gastroscopy – Child-Pugh classification – liver cirrhosis – esophageal and gastric varices – portal vein


1. Rigo GP, Merighi A, Chahin NJ et al. A prospective study of the ability of three endoscopic classifications to predict hemorrhage from esophageal varices. Gastrointest Endosc 1992; 38(4): 425–429.

2. Pascal JP, Cales P, Multicenter Group. Propranolol in the prevention of first upper gastro­intestinal tract hemorrhage in pa­tients with cirrhosis of the liver and esophageal varices. N Engl J Med 1987; 317(14): 856–861.

3. Sauerbruch T, Kleber G. Upper gastro­intestinal endoscopy in patients with portal hypertension. Endoscopy 1992; 24(1–2): 45–51.

4. Caletti G, Brocchi E, Baraldini M et al. Assessment of portal hypertension by endoscopic ultrasonography. Gastrointest Endosc 1990; 36 (2 Suppl): 521–527.

5. Caletti GC, Bolondi L, Zani L et al. Detection of portal hypertension and esophageal varices by means of endoscopic ultrasonography. Scand J Gastroenterol 1986; 21: 74–77.

6. Degradi AE. The natural history of esophageal varices in patients with alcoholic liver cirrhosis. An endoscopic and clinical study. Am J Gastroenterol 1972; 57(6): 520–540.

7. Lebrec D, Fleury P, Reuff B et al. Portal hyperten­sion, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology 1980; 79(6): 1139–1144.

8. Cales P, Vinel J-P, Caucanas J-P et al. Incidence of large oesophageal varices in pa­tients with cirrhosis: application to prophylaxis of first bleeding. Gut 1990; 31(11): 1298–1302.

9. The North Italian Endoscopic Club for the Study and Treatment of Esopha­geal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. N Engl J Med 1988; 319(15): 983–989.

10. Cales P, Zabotto B, Meskens C et al. Gastroesophageal endoscopic features in cirrhosis. Observer variability, interassociations, and relationship to hepatic dysfunction. Gastroenterology 1990; 98(1): 156–162.

11. Beppu K, Inokuchi K, Koyanagi N et al. Prediction of variceal hemorrhage by esophageal endoscopy. Gastrointest Endosc 1981; 27(4): 213–218.

12. Seno H, Konishi Y, Wada M et al. Endoscopic ultrasonograph evaluation of vascular structures in the gastric cardia predicts esophageal variceal recurrence following endoscopic treatment. J Gastroenterol Hepatol 2006; 21(1 Pt 2): 227–231.

13. Liu J-B, Miller LS, Feld RI et al. Gastric and esophageal varices: 20 MHz transnasal endoluminal US. Radiology 1993; 187(2): 363–366.

14. Garcia-Tsao G, Sanyal AJ, Grace ND et al. Practice Guidelines Committee of the American Association for the Study of Liver Diseases; Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology 2007; 46(3): 922–938.

15. Arun JS, Vijay HS. Portal hypertension: pathobiology, evaluation, and treatment. New Jersey: Humana Press, 2005.

16. Seno H, Konishi Y, Wada M et al. Improvement of collateral vessels in the vicinity of gastric kardia after endoscopic variceal ligation therapy for esophageal varices. Clin Gastroenterol Hepatol 2004; 2(5): 400–404.

17. Irisawa A, Shibukawa G, Obara K et al. Collateral vessels around the esophageal wall in patients with portal hypertension: comparison of EUS imaging and microscopic findings at autopsy. Gastrointest Endosc 2002; 56(2): 249–253.

18. Irisawa A, Obara K, Sato Y et al. EUS analysis of collateral veins inside and outside the esophageal wall in portal hypertension 1999; 50(3): 374–80.

19. Burtin P, Calés P, Oberti F et al. Endoscopic ultrasonographic signs of portal hypertension in cirrhosis. Gastrointest Endosc 1996; 44(3): 257–261.

20. Conn HO, Smith H, Brodoff M. Observer variation in the esophagoscopic diagnosis of esophageal varices. A prospective investigation of the diagnos­tic validity of esophagoscopy. N Engl J Med 1965; 272: 830–834.

21. Miller LS, Schiano TD, Adrain A et al. Comparison of high – resolution endoluminal sonography to video endoscopy in the detection and evaluation of esophageal varices. Hepatology 1996; 24(3): 552–555.

22. Sgouros SN, Bergele C, Avgerinos A. Endoscopic ultrasonography in the diagnosis and management of portal hypertension. Where are we next? Dig Liver Dis 2006; 38(5): 289–295. Epub 2006 Jan 18. Review

23. 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(2): 197–203.

24. Dítě P. Současnost endoskopické terapie chronické pankreatitid. Čes a Slov Gastroent a Hepatol 2005; 59(3): 99–104.

25. Dítě P et al. Chronická pankreatitida. 1. vyd. Praha: Galén 2002.

26. Irisawa A, Saito A, Obara K et al. Usefulness of endoscopic ultrasonographic analysis of variceal hemodynamics for the treatment of esophageal varices. Fukushima J Med Sci 2001; 47(2): 39–50.

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(4): 512–517.

28. Irisawa A, Saito A, Obara K et al. Usefulness of endoscopic ultrasonographic analysis of variceal hemodynamics for the treatment of esophageal varices. Fukushima J Med Sci 2001; 47(2): 39–50.

29. Miller L, Banson FL, Bazir K et al. Risk of esophageal variceal bleeding based on endoscopic ultrasound evaluation of the sum of esophageal variceal cross-sectional surface area. Am J Gastroenterol 2003; 98(2): 454–459.

30. Schiano TD, Adrain AL, Vega KJ et al. High-resolution endoluminal sonography assessment of the hematocystic spots of esophageal varices. Gastrointest Endosc 1999;49(4 Pt 1):424–427.

31. Schiano TD, Adrain AL, Cassidy MJ et al. Use of high-resolution endoluminal sonography to measure the radius and wall thickness of esophageal varices. Gastrointest Endosc 1996; 44(4): 425–428.

32. Pontes JM, Leitao MC, Portela F et al. Endosonographic Doppler-guided manometry of esophageal varices: experimental validation and clinical feasibility. Endoscopy 2002; 34(12): 966–972.

33. Salama ZA, Kassem AM, Giovannini M et al. Endoscopic ultrasonographic study of the azygos vein in patients with varices. Endoscopy 1997; 29(8): 748–750.

34. Parasher VK, Meroni E, Malesci A et al. Observation of thoracic duct morphology in portal hypertension by endoscopic ultrasound. Gastrointest Endosc 1998; 48(6): 588–592.

Paediatric gastroenterology Gastroenterology and hepatology Surgery

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