Role of para-esophageal collateral veins in patients with portal hypertension based on the results of endoscopic ultrasonography and liver scintigraphy analysis

Background and Aims: Para-esophageal collateral veins (para-ECV) are observed by endoscopic ultrasonography (EUS) in patients with portal hypertension. However, the role of para-ECV in the portal venous system is not clear. To verify the role of para-ECV in the portal venous system, we investigated the relationship between the development of para-ECV as determined by EUS, and the portal blood flow ratio (PBFR) as determined by liver scintigraphy using ^99mTc-phytate. Methods: Eighteen patients who did not have fundal gastric varices were studied before the start of and after the completion of all endoscopic sclerotherapy sessions for esophageal varices. EUS was performed to observe veins around the esophagus, para-ECV and perforating veins. To quantify the degree of development of para-ECV, the cross-sectional area of each para-ECV observed by EUS was measured. The sum total of these areas was used as an index of development of para-ECV. The PBFR was calculated by liver scintigraphy using ^99mTc-phytate. The correlation between the sum total cross-sectional area of para-ECV and PBFR was examined. Results: After all endoscopic injection sclerotherapy sessions, the total cross-sectional area of para-ECV was 29.32 (26.72) mm² (mean (SD)) and the PBFR was 48.47 (17.87)% (mean (SD)). A significant correlation between them was noted after treatment (r=-0.70, P<0.01). Variceal recurrence was observed in three of the patients who had perforating veins connected with para-ECV, regardless of degree of the para-ECV. Conclusion: The para-ECV are collaterals, which reflect the portal blood flow after endoscopic sclerotherapy, para-ECV without perforating veins were considered to be important collaterals after treatment.