Study on the blood supply and collateral circulation of esophageal gastric varicose / 中华消化内镜杂志

ABSTRACT

Objective To detect the esophageal and fundal varices and their related collateral ves-sels by multi-detector row CT ( MDCT) in helping to find out the objective evidences for selecting treatment measure and predicting prognosis. Methods Fifty-one patients with clinical diagnosis of cirrhosis were in-cluded in this study. Esophageal varices were confirmed by endoscopy in all patients, of which 31 accompa-nied with fundal varices. All patients underwent MDCT angiography to demonstrate collaterals between the systemic and portal circulation as well as the esophageal varicose. Results Good or excellent image quality was obtained in all patients. Gastric fundal varices were found in 31 of 51 patients (60. 8% )by endoscopies. By MDCT angiography esophageal varies were confirmed in all patients, gastric fundal varices were in 32 of 51 (62. 7% ). There are high degree of concordance Kappa =0. 876 between them. Esophageal varices were supplied mainly by the left gastric vein ( LGV) , by anterior branch of LGV alone in 30 of 51 (58. 8% ). There were paraesophageal veins in 21 of 51 patients (41.2%). Gastric fundal varices were supplied by LGV in 24 of 32 patients (75% ), by short gastric veins /posterior gastric veins in 3 of 32 patients (9. 4% ) and by short gastric veins /posterior gastric veins and LGV together in 5 of 32 patients ( 15. 6% ). Short gas-tric veins and posterior gastric veins participate in forming of esophageal varices in these patients. Conclusion MDCT angiography shows an excellent vascular maps and highly in concordance with endoscopy in terms of the detection of esophageal and gastric fundal varices. Esophagal varices were supplied mainly by LGV, more than half of them were by its anterior branch, and paraesophageal veins participated to it in some patients too. The blood flow in gastric fundal varices were supplied from LGV in most of the patients, and the rest from short gastric veins.