Kakutani H, Hino S, Ikeda K, Mashiko T, Sumiyama K, Uchiyama Y, Kuramochi A, Kitamura Y, Matsuda K, Kawamura M, Tajiri H, Urashima M
Department of Endoscopy, Jikei University School of Medicine, Tokyo, Japan.
Endoscopy. 2004 Aug;36(8):710-4. doi: 10.1055/s-2004-825658.
: Balloon-occluded retrograde transvenous obliteration (B-RTO) has emerged as an effective, minimally invasive treatment for fundal varices. B-RTO requires a spontaneously developed gastrorenal shunt as a pathway for the balloon catheter to reach the fundal varices. We used a curved linear-array (CLA) echo endoscope in patients with fundal varices to identify gastrorenal shunts, and compared the detection rate with the gold standard, contrast-enhanced computed tomography (CECT).
A total of 40 patients with fundal varices were examined with both CLA echo endoscopy and CECT. The CECT images were retrospectively and independently evaluated by two gastroenterologists who were unaware of the clinical details, including the results of the CLA echo endoscopy.
CLA echo endoscopy identified gastrorenal shunts in 26/40 patients with fundal varices. It visualized the shunt in a longitudinal direction and provided images of the connections of the shunt at both ends, the fundal varices and the left renal vein/branch of the inferior adrenal vein. The kappa index for CLA echo endoscopy and CECT for the identification of gastrorenal shunt was 0.9 (95 % CI, 0.6 to 1.0). When the cutoff point for the diameter of the gastrorenal shunt detected by the CLA echo endoscope was set at equal to or greater than 5 mm, the kappa index was 1.0 (95 % CI, 0.7 to 1.0).
These results suggest that CLA echo endoscopy can successfully identify gastrorenal shunt and provide detailed morphological information. It also efficiently identifies patients suitable for B-RTO, particularly in cases of acute bleeding. It also has considerable potential for providing detailed information with regard to the treatment of gastric varices.
球囊闭塞逆行静脉栓塞术（B-RTO）已成为治疗胃底静脉曲张的一种有效、微创的治疗方法。B-RTO需要一个自发形成的胃肾分流作为球囊导管到达胃底静脉曲张的通路。我们使用弯曲线阵（CLA）超声内镜来识别胃底静脉曲张患者的胃肾分流，并将其检出率与金标准——对比增强计算机断层扫描（CECT）进行比较。
共有40例胃底静脉曲张患者接受了CLA超声内镜检查和CECT检查。两名不了解临床细节（包括CLA超声内镜检查结果）的胃肠病学家对CECT图像进行了回顾性独立评估。
CLA超声内镜在40例胃底静脉曲张患者中识别出26例胃肾分流。它能纵向显示分流，并提供分流两端、胃底静脉曲张以及左肾静脉/肾上腺下静脉分支连接的图像。CLA超声内镜与CECT识别胃肾分流的kappa指数为0.9（95%CI，0.6至1.0）。当CLA超声内镜检测到的胃肾分流直径的截断点设定为等于或大于5mm时，kappa指数为1.0（95%CI，0.7至1.0）。
这些结果表明，CLA超声内镜能够成功识别胃肾分流并提供详细的形态学信息。它还能有效地识别适合B-RTO治疗的患者，尤其是在急性出血的情况下。它在提供有关胃静脉曲张治疗的详细信息方面也具有相当大的潜力。
