99mTc-DTPA activity in the azygos vein before and after sclerotherapy in patients with cirrhosis

Role of para-esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis

BACKGROUND AND AIMS

Para-esophageal collateral veins (para-ECV) are observed by endoscopic ultrasonography (EUS) in patients with portal hypertension. However, the role of para-ECV in the portal venous system is not clear. To verify the role of para-ECV in the portal venous system, we investigated the relationship between the development of para-ECV as determined by EUS, and the portal blood flow ratio (PBFR) as determined by liver scintigraphy using 99mTc-phytate.

METHODS

Eighteen patients who did not have fundal gastric varices were studied before the start of and after the completion of all endoscopic sclerotherapy sessions for esophageal varices. EUS was performed to observe veins around the esophagus, para-ECV and perforating veins. To quantify the degree of development of para-ECV, the cross-sectional area of each para-ECV observed by EUS was measured. The sum total of these areas was used as an index of development of para-ECV. The PBFR was calculated by liver scintigraphy using 99mTc-phytate. The correlation between the sum total cross-sectional area of para-ECV and PBFR was examined.

RESULTS

After all endoscopic injection sclerotherapy sessions, the total cross-sectional area of para-ECV was 29.32 (26.72) mm2 (mean (SD)) and the PBFR was 48.47 (17.87)% (mean (SD)). A significant correlation between them was noted after treatment (r = - 0.70, P < 0.01). Variceal recurrence was observed in three of the patients who had perforating veins connected with para-ECV, regardless of degree of the para-ECV.

CONCLUSION

The para-ECV are collaterals, which reflect the portal blood flow after endoscopic sclerotherapy. para-ECV without perforating veins were considered to be important collaterals after treatment.

Hepatocellular carcinoma in glycogen storage disease type IV

A 13 year old patient with juvenile type IV glycogen storage disease died of the complications of hepatocellular carcinoma. To our knowledge this is the first reported case of hepatocellular carcinoma in association with type IV glycogen storage disease.

Splenic arteriovenous fistula. A rare lesion causing bleeding esophageal varices, ascites, and diarrhea

We report the case of a 39-year-old woman with portal hypertension caused by a splenic arteriovenous fistula that was diagnosed by Doppler ultrasound and splenic arteriography. She presented with esophageal variceal hemorrhage and was initially treated with sclerotherapy. Ascites and secretory diarrhea then developed. At laparotomy portal pressure was 60 cm H2O but fell to 26 cm H2O after the fistula was resected with a splenectomy. All symptoms disappeared shortly thereafter, and the patient has remained well for the past two years.