Catheter US probe EUS evaluation of gastric cardia and perigastric vascular structures to predict esophageal variceal recurrence.

BACKGROUND This study assessed the risk of recurrence of esophageal varices by evaluating the severity of cardia vascular structures in patients with portal hypertension by EUS with a catheter US probe before endoscopic variceal ligation. METHODS Thirty consecutive patients with esophageal varices at high risk for bleeding were studied. Simultaneous conventional endoscopy and EUS with a 20 MHz catheter US probe were performed before endoscopic variceal ligation. By catheter US probe EUS findings, vascular structures in the gastric cardia were classified into 2 grades, mild and severe, and the relationship between the catheter US probe EUS findings and the recurrence rate of esophageal varices was analyzed. RESULTS Catheter US probe EUS before endoscopic variceal ligation demonstrated cardial submucosal varices in all patients, whereas conventional endoscopy revealed cardial varices in only 21 patients (70.0%, NS). Patients with recurrent esophageal varices after endoscopic variceal ligation were more likely to have severe-grade perforating veins before treatment than those without recurrence (71.4% vs. 12.5%, p < 0.01). Patients with severe as opposed to mild-grade perforating veins before treatment had a significantly higher recurrence rate (90.9% vs. 21.0%, p < 0.01%). CONCLUSIONS Catheter US probe EUS findings for cardial vascular structures before treatment are useful for predicting the likelihood of recurrence of esophageal varices.