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Esophageal varices: evaluation with transabdominal US
1Department of Radiology, School of Medicine, Hokkaido University, Sapporo, Japan.
Purpose:
To prospectively evaluate the clinical usefulness of transabdominal ultrasound (US) in the detection of esophageal varices.
Materials And Methods:
Transabdominal US was performed in 47 patients (30 men, 17 women; age range, 18-75 years) with liver cirrhosis or idiopathic portal hypertension. The intraabdominal esophagus was demonstrated satisfactorily, and the findings were correlated with the presence of esophageal varices at endoscopy and angiography. The thickness of the anterior wall of the intraabdominal esophagus was measured and the irregularity of the wall surface documented. Blood flow signal in the esophageal wall also was evaluated with color Doppler and pulsed Doppler examinations.
Results:
The mean thickness of the esophageal wall was 5.7 mm +/- 1.7 (standard deviation) in patients with esophageal varices and 3.6 mm +/- 0.96 in patients without varices. This difference was statistically significant (P < .001). Varices also caused irregular wall surfaces. Another specific finding was hepatofugal venous flow within the esophageal wall at Doppler examination. When an esophageal wall thickness of at least 5 mm or an irregular wall surface was used as a diagnostic criterion for esophageal varices, the sensitivity, specificity, and accuracy were 93%, 82%, and 89%, respectively.
Conclusion:
Transabdominal US can play a role in screening for esophageal varices. The intraabdominal esophagus should be observed during standard abdominal US in patients with chronic liver disease.