Nagamine N, Ido K, Ueno N, Kimura K, Kawamata T, Kawada H, Hirasawa T, Suzuki T, Kubo H, Tokumaru K, Seki M
Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
Am J Gastroenterol. 1996 Mar;91(3):523-9.
This study investigated whether ultrasonic microprobe (UMP) imaging was useful in judging the therapeutic effect of endoscopic variceal (EVL) on varices as well as assessing varices and surrounding vessels before and after EVL.
UMP imaging was performed repeatedly safely and easily via the biopsy channel of an endoscope in 20 patients with esophageal varices. Using this modality in combination with our method of "intensive ligation," we treated esophageal varices successfully.
Before EVL, UMP imaging displayed esophageal varices, periesophageal collaterals, and the azygous vein as echo-free lumens. In 15 of 20 patients, UMP imaging clearly detected the perforating vein, one of the optimal ligation sites for EVL, connecting the varix and collateral vein. Just after EVL, UMP imaging revealed a hyperechoic change ("snow ball" sign or "snow channel" sign), indicating blood flow stasis in the esophageal varices. On subsequent EVL, UMP imaging showed the cross-sectional area of varices was undetectable (occluded) or partially detectaable. After repeated EVL (2.9 treatment sessions on average), UMP imaging, as well as endoscopy, indicated that almost all varices were eradicated (undetectable). However, UMP imaging demonstrated that neither collaterals nor the azygous vein had significantly changed in size.
This modern diagnostic modality provided a clinical adjunct to current endoscopy when observing esophageal varices and surrounding vessels before and after EVL to determine the need for additional therapy.
本研究探讨超声微探头（UMP）成像在判断内镜下静脉曲张结扎术（EVL）对静脉曲张的治疗效果以及评估EVL前后静脉曲张和周围血管情况方面是否有用。
通过内镜活检通道对20例食管静脉曲张患者安全、简便地反复进行UMP成像。结合我们的“密集结扎”方法，成功治疗了食管静脉曲张。
EVL前，UMP成像显示食管静脉曲张、食管周围侧支循环和奇静脉为无回声腔。20例患者中有15例，UMP成像清晰检测到连接静脉曲张和侧支静脉的穿支静脉，这是EVL的最佳结扎部位之一。EVL刚结束后，UMP成像显示高回声改变（“雪球”征或“雪道”征），提示食管静脉曲张内血流淤滞。在后续的EVL中，UMP成像显示静脉曲张的横截面积不可检测（闭塞）或部分可检测。重复EVL（平均2.9次治疗）后，UMP成像以及内镜检查表明几乎所有静脉曲张均被根除（不可检测）。然而，UMP成像显示侧支循环和奇静脉的大小均无明显变化。
这种现代诊断方式在观察EVL前后食管静脉曲张和周围血管以确定是否需要额外治疗时，为当前的内镜检查提供了一种临床辅助手段。
