Evaluation of patients with esophageal varices after endoscopic injection sclerotherapy using multiplanar reconstruction MDCT images.

Abstract

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. 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. 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 (>or= 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. MPR MDCT images on portosystemic collaterals can accurately predict relapse of esophageal varices after endoscopic injection sclerotherapy.