4903
document
Magnetic resonance angiography for monitoring prophylactic endoscopic treatment of high risk esophageal varices . BACKGROUND AND STUDY AIMS Endoscopic injection sclerotherapy ( EIS ) and endoscopic variceal ligation ( EVL ) are used worldwide as the treatment for esophageal varices . We evaluated portal hemodynamics using magnetic resonance angiography ( MRA ) in these two forms of treatment . PATIENTS AND METHODS The study was carried out in 50 cirrhotic patients . MRA was performed to identify the hepatofugal supply vein selectively for esophageal varices . Those who showed a positive MR angiogram for the supply vein were randomly allocated to one of two groups , using the sealed envelope method , and underwent either EIS or EVL . On the other hand , those with a negative angiogram received only EVL . EIS was done to embolize esophageal varices as well as their feeders by intravariceal injection of sclerosant under fluoroscopic guidance . RESULTS A positive MR angiogram of the hepatofugal left gastric vein as the supply vein was observed in 41 patients . Nine patients showed negative MRA results . Among those with positive angiograms , the rate of eradication of the left gastric vein was higher in the EIS-treated group than in the EVL treated group ( 50 % vs. 8.6 % ) . After either treatment , the recurrence-free rate for high risk esophageal varices was higher in patients with complete eradication of the left gastric vein than in those without ( 88 % vs. 35 % ) . In patients with negative angiogram results , who only underwent EVL , high risk esophageal varices did not reappear over a long period . CONCLUSION MRA is useful for evaluating portal hemodynamics . With the aim of avoiding recurrence of esophageal varices , EIS was suitable for patients who had a hepatofugal supply vein for the varices because recurrence could be prevented by embolization of the supply vein . EVL may be expected to be efficacious in patients where no image of a hepatofugal supply vein is found on MRA .
4904
Intervention_Pharmacological
Endoscopic injection sclerotherapy ( EIS )
4905
Intervention_Surgical
endoscopic variceal ligation ( EVL )
4906
Intervention_Pharmacological
EIS
4907
Intervention_Surgical
EVL
4908
Intervention_Pharmacological
EIS
4909
Outcome_Physical
rate of eradication of the left gastric vein
4910
Outcome_Physical
recurrence-free rate for high risk esophageal varices
4911
Outcome_Physical
risk esophageal varices
4912
Participant_Sample-size
50
4913
Participant_Condition
cirrhotic
4914
Participant_Condition
esophageal varices .
4915
Participant_Sample-size
41
4916
Participant_Sample-size
Nine
4917
Participant_Condition
negative MRA results .