| Objective:CT portal venography（CTPV) can display collateral circulation anddrainage paths of varices non-invasively and stereoly, and it has goodconsistency with endoscopy in observation of esophageal and gastric varices.It has unique value especially for judgment and distribution of varices outsidethe esophagus and paraesophageal varices. A combined application of CTPVand endoscopy maks a further comprehensive understanding of the overalldistribution of portal collateral vessels, and it has great significance as to thechoice of treatments of esophageal and gastric varices, as well as theevaluation of efficacy and prevention of complications.In recent years, CTPV is increasingly widely used in the evaluation ofcollateral circulation in portal hypertension, however, CTPV studies ofendoscopic treatments in patients with esophageal and gastric varices arerarely covered. This research aims to apply CTPV to assess conditionspreoperatively and estimate efficacy postoperatively in patients withesophageal and gastric varices and explore the diagnostic and therapeuticvalues of CTPV.Method: We collected33cases of clinically proven cirrhosis patientshospitalized in our department with history of esophagealgastric varicealbleeding, which were evaluated by CT portal venography and endoscopyrespectively from December2012to December2013. Esophageal variceswere graded and gastric varices were typed. Various images post-processingtechniques such as maximum intensity projection and volume rendering wereapplied to depict the portal systems, and diameters of portal vein and its majortributaries were measured.Patients then underwent endoscopic therapies based on their types of LDRf. A total of24cases underwent endoscopic therapies, among which therewere7cases of esophageal variceal endoscopic variceal ligation,4cases ofesophageal variceal endoscopic sclerotherapy, and1case of endoscopiccyanoacrylate injection of esophageal varices. There were8cases ofendoscopic cyanoacrylate injection of gastric varices, and4cases ofcombinative endoscopic therapies of esophagealgastric varices. All these24patients underwent endoscopy and CTPV1week and1month aftertreatments, and diameters of portal vein and its main branches were measured.The degree of reduction of varices was also assessed. And then evaluated theefficacy of endoscopic therapies comprehensively.Results:1Characteristics in patients with esophageal and gastric varices on CTPVimagesCTPV detected30cases of esophageal varices (90.9%),28cases ofgastric varices (84.8%),1case of duodenal varices (3.0%),21cases ofparaesophageal varices (63.6%),5cases of abdominal wall varices (15.2%),and2cases of paravertebral varices(6.2%). In all inflow roads, left gastric veinwas found in28cases (84.8%), and short gastric vein and posterior gastricveins were found in19cases (57.6%). In all outflow roads, azygos vein wasfound in27cases (81.9%), spontaneous gastric/spleno-renal shunts were foundin17cases (51.5%). The left inferior phrenic vein drainage was not found, nordoes spontaneous gastro-pulmonary shunts.According to the grading of esophageal varices made by Kim, there were4cases of grade Ⅰ(12.1%),6cases of gradeⅡ (18.2%),20cases of gradeⅢ (60.6%), and3negative cases(9.1%). According to the typing of gastricvarices made by Sarin, type of GOV1was found in15cases (45.5%), type ofGOV2was found in15cases (45.5%), and type of IGV1as well as IGV2wasfound in1case (3.0%)respectively.2Endoscopic manifestations of esophageal and gastric varicesEndoscopy diagnosed30cases of esophageal varices (90.9%),29casesof gastric varices (87.8%), and1case of duodenal varices (3.0%). In the classification of esophageal varices, mild esophageal varices were found in3cases (9.1%), moderate esophageal varices were found in7cases(21.2%),severe esophageal varices were found in20cases (60.6%), and3cases werenegative (9.1%). In the typing of gastric varices, there were17cases of GOV1(51.5%),13cases of GOV2(39.4%), and2cases of type IGV1(6.0%), andtype of IGV2was found in1case(3.0%).3Consistency of CTPV with endoscopeDiagnosis of esophageal varices made by CTPV and endoscopy is wellconsistent, with the Kappa value of0.633, P＜0.05. The diagnosis of gastricvarices made by CTPV and endoscopy is well consistent, with the Kappavalue of0.615, P＜0.05. CTPV and endoscopy have a good consistency in thetyping of gastric varices, with the Kappa value of0.739，P＜0.05. CTPV andendoscopy have a high consistency in grading of esophageal varices, with theKappa value of0.684, P＜0.05.4Evaluation of therapeutic efficacy of endoscopic treatments4.1Changes of diameters of the portal vein and its main branches afterendoscopic treatmentsBefore treatments,1week and1month after treatments, the diameters ofportal vein, splenic vein, and superior mesenteric vein didn’t change obviously,with no statistically significance. The diameter of portal vein was1.64±0.34cm,1.65±0.35cm, and1.67±0.36cm respectively. The diameter ofsplenic vein was1.26±0.27cm,1.24±0.27cm, and1.23±0.25cmrespectively. The diameter of superior mesenteric vein was1.10±0.25cm,1.08±0.21cm, and1.08±0.22cm respectively.The diameter of left gastric vein was gradually decreased, from0.72±0.06cm to0.67±0.06cm, and then to0.61±0.06cm, with statisticallysignificance.4.2Efficacy of endoscopic therapies detected by CTPV and endoscopy.A total of16cases underwent endoscopic treatment of esophagealvarices, among which6cases were found effective1week after treatmentsjudged by CTPV, with an overall effective rate of37.5%, and8cases were found effective as well as2cases obviously effective1month after treatments,with an overall effective rate of62.5%. While there were2cases foundeffective1week after treatments judged by endoscopy, with an overalleffective rate of12.5%, and3cases were found effective as well as1caseobviously effective1month after treatments, with an overall effective rate of25%.A total of12cases underwent endoscopic treatment of gastric varices,among which2cases were found effective as well as1case obviouslyeffective1week after treatments judged by CTPV, with an overall effectiverate of25%, and4cases were found effective as well as3cases obviouslyeffective1month after treatments, with an overall effective rate of58.3%.While there were1case found effective and1case found obviously effective1week after treatments judged by endoscopy, with an overall effective rate of16.6%, and there were3cases found effective and2case found obviouslyeffective1month after treatments, with an overall effective rate of46.1%.4.3Seven of the twenty four patients who underwent endoscopic therapiesfound portal vein thrombosis, with the incidence rate of29.2%.Conclusions:1CTPV provides a clear display and distribution of portal vein systemnon-invasively, as well as drainage paths of varices, and it can show the spatialrelationship of collateral circulation through reconstruction of images.2The consistencies of existence, classification and grading of esophageal andgastric varices of CTPV and endoscopy are good.3After endoscopic therapies of esophageal and gastric varices, left gastricvein is significantly reduced in diameter detected by CTPV in the short term(1week and1month after treatments). The effective rate of endoscopictherapies of esophageal varices and gastric varices detected by CTPV is62.5%and58.3%respectively. CTPV provides a well clinical guidance in theassessment of endoscopic therapy in patients with esophageal and gastricvarices. |
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