Burtin P, Calès P, Oberti F, Joundy N, Person B, Carpentier S, Boyer J
Hepato-Gastroenterology Unit, University Hospital, Angers, France.
Gastrointest Endosc. 1996 Sep;44(3):257-61. doi: 10.1016/s0016-5107(96)70161-x.
Endoscopic ultrasonography (EUS) has been suggested to investigate portal hypertension (PHT). We compared EUS and endoscopy in the exploration of PHT in cirrhosis.
In 58 patients with cirrhosis and 16 controls, the presence of esophageal varices and gastric varices was recorded by both endoscopy and EUS, peridigestive varices and perforating veins by EUS. Relationships of patterns with each other and with clinical and biologic data were evaluated.
In patients with cirrhosis: esophageal varices were found by endoscopy and EUS in 88% and 55% of cirrhotic cases (p < 0.01), and gastric varices in 17% and 41%, respectively (p < 0.01). Perforating veins, below the gastroesophageal junction, were diagnosed by EUS in 40% of cases and never in controls. A significant relationship was found between perforating veins and the following patterns: peri-digestive varices, gastric varices at EUS, and esophageal varices at endoscopy. In patients with and without cirrhosis: after multivariate analysis, only esophageal varices at endoscopy were independently related to cirrhosis. However, in Child-Pugh class A patients, both esophageal varices and perforating veins were independently related to cirrhosis (diagnostic accuracy, 92%).
EUS is of limited value in the diagnosis of cirrhosis because it gives little additional information to upper gastrointestinal endoscopy. The relationships between perforating veins, varices, and peridigestive varices support the hypothesis that perforating veins are important in the pathogenesis of esophageal and gastric varices.
内镜超声检查（EUS）已被用于研究门静脉高压症（PHT）。我们比较了EUS和内镜检查在肝硬化门静脉高压症探查中的应用。
对58例肝硬化患者和16例对照者，通过内镜检查和EUS记录食管静脉曲张和胃静脉曲张的情况，通过EUS记录消化管周围静脉曲张和穿支静脉情况。评估各种静脉曲张模式之间以及与临床和生物学数据之间的关系。
在肝硬化患者中：内镜检查和EUS发现食管静脉曲张的比例分别为88%和55%（p<0.01），胃静脉曲张的比例分别为17%和41%（p<0.01）。EUS诊断出40%的病例在胃食管交界处下方存在穿支静脉，而对照组未发现。穿支静脉与以下模式之间存在显著关系：消化管周围静脉曲张、EUS发现的胃静脉曲张以及内镜检查发现的食管静脉曲张。在有和没有肝硬化的患者中：多因素分析后，仅内镜检查发现的食管静脉曲张与肝硬化独立相关。然而，在Child-Pugh A级患者中，食管静脉曲张和穿支静脉均与肝硬化独立相关（诊断准确率92%）。
EUS在肝硬化诊断中的价值有限，因为它对上消化道内镜检查几乎没有提供额外信息。穿支静脉、静脉曲张和消化管周围静脉曲张之间的关系支持了穿支静脉在食管和胃静脉曲张发病机制中起重要作用的假说。
