Use of the curved linear-array echo endoscope to identify gastrorenal shunts in patients with gastric fundal varices
Use of the curved linear-array echo endoscope to identify gastrorenal shunts in patients with gastric fundal varices
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DOI：
10.1055/s-2004-825658
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发表时间：
2004-08-01
期刊：
影响因子：
9.3
通讯作者：
Urashima, M
中科院分区：
文献类型：
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作者：
Kakutani, H;Hino, S;Urashima, M
背景和研究目的：逆行经静脉闭塞术（B-RTO）已成为治疗胃底静脉曲张的有效微创治疗方法。B-RTO需要自发形成的胃肾分流作为球囊导管到达胃底静脉曲张的通路。我们使用了弯曲的线性阵列（CLA）回声内镜与胃底静脉曲张患者，以确定胃肾分流，并比较金标准，对比增强计算机断层扫描（CECT）的检出率。患者和方法：共40例胃底静脉曲张患者进行了检查与CLA回声内镜和CECT。CECT图像进行了回顾性和独立的评价，由两个胃肠病学家谁不知道的临床细节，包括结果的CLA回声endoscopy.Results：CLA回声endoscopy确定胃肾分流在26/40例胃底静脉曲张。它在纵向上显示了分流管，并提供了分流管两端连接、底静脉曲张和左肾静脉/肾上腺下静脉分支的图像。CLA超声内镜和CECT识别胃肾分流的kappa指数为0.9（95% CI，0.6 - 1.0）。当CLA超声内镜检测到胃肾分流管直径的截断点设为≥ 5 mm时，Kappa指数为1.0（95%CI，0.7 ~ 1.0）。结论：CLA超声内镜能成功地识别胃肾分流管，并能提供详细的形态学信息。它还可以有效地识别适合B-RTO的患者，特别是在急性出血的情况下。它也有相当大的潜力，提供详细的信息，治疗胃静脉曲张。
Background and Study Aims: Balloon-occluded retrograde transvenous obliteration (B-RTO) has emerged as an effective, minimally invasive treatment for fundal varices. B-RTO requires a spontaneously developed gastrorenal shunt as a pathway for the balloon catheter to reach the fundal varices. We used a curved linear-array (CLA) echo endoscope in patients with fundal varices to identify gastrorenal shunts, and compared the detection rate with the gold standard, contrast-enhanced computed tomography (CECT).Patients and Methods: A total of 40 patients with fundal varices were examined with both CLA echo endoscopy and CECT. The CECT images were retrospectively and independently evaluated by two gastroenterologists who were unaware of the clinical details, including the results of the CLA echo endoscopy.Results: CLA echo endoscopy identified gastrorenal shunts in 26/40 patients with fundal varices. It visualized the shunt in a longitudinal direction and provided images of the connections of the shunt at both ends, the fundal varices and the left renal vein/branch of the inferior adrenal vein. The kappa index for CLA echo endoscopy and CECT for the identification of gastrorenal shunt was 0.9 (95% Cl, 0.6 to 1.0). When the cutoff point for the diameter of the gastrorenal shunt detected by the CLA echo endoscope was set at equal to or greater than 5 mm, the kappa index was 1.0 (95 % Cl, 0.7 to 1.0).Conclusions: These results suggest that CLA echo endoscopy can successfully identify gastrorenal shunt and provide detailed morphological information. It also efficiently identifies patients suitable for B-RTO, particularly in cases of acute bleeding. It also has considerable potential for providing detailed information with regard to the treatment of gastric varices.