The role of endoscopic Doppler-sonography.

Endoscopic Doppler sonography is a useful method that permits a differentiation to be made between high-risk lesions in danger of rebleeding and prognostically harmless ulcerations. Using this technique, vessels in the base of the ulcer can be reliably identified, and the indication for local endoscopic treatment established. The pulsed Doppler can be used to test the efficacy of prior endoscopic therapy within the framework of follow-up investigations; when arterial blood flow signals are found to persist, treatment needs to be repeated. With the aid of this "programmed" Doppler sonography-controlled endoscopic approach, which in some cases may be repeatable, the number of rebleeds, emergency operations, and probably also mortality, can be permanently lowered. Endoscopic Doppler sonography can also provide important additional information in the area of primary diagnosis and endoscopic treatment of esophageal and gastric varices. The Doppler exploration facilitates the assessment of the sclerosing effect, and is capable of identifying gastric varices and distinguishing these from other submucosal processes. For an assessment of the butyl cyanoacrylate varix, the Doppler is of particular value.