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21 May 2009

Upper gastrointestinal echoendoscopy (EUS) in patients assessed for liver transplantation

A Wiechowska-Kozłowska, J Raszeja-Wyszomirska, A Białek, E Wunsch, M Wójcicki, P Milkiewicz

Ann Transplant 2009; 14(1): 39-39 :: ID: 880340


Background: Endosonography(EUS), which combines endoscopy and ultrasound examination is an excellent tool for detection of abnormal vessels of intrinsic circulation, frequently called "deep" varices. These varices, if exceed the diameter of 5mm significantly increase the risk of bleeding. In most recent, pilot study EUS proved very useful in assessment for liver transplantation (LTx) in children (McKiernan et al., Transplantation 2008).
Aim: Cross-sectional, EUS study on 33 (22 males,11 females) adults with cirrhosis, assessed for LTx.
Material/Methods: Echoendoscope (Olympus GF-UMQ-130) at 7.5 MHz/12
MHz/20MHz was used. Endoscopic features were evaluated fi rst followed by
detailed EUS examination of the oesophagus and stomach. Assessment included "deep" perioesophageal/perigastric varices (adjacent to the muscularis propria) and paraoesophageal/paragastric varices (outside the muscularis propria). "Deep" varices were considered large if >5mm.
Results: On endoscopy, 26(79%) had oesophageal varices (OV), including 11(33%) patients with large (grade II/III) varices. Gastric varices (GV) were seen in 13(39%), with 3 patients who had large (>5 mm) varices. On EUS large "deep" OV (both para and perioesophageal) were seen in 12 (36%), amongst whom 5 (42%) did not have large varices on endoscopy. Large "deep" GV were found on EUS in 12 (36%) subjects. On endoscopy four of them (33%) had no varices and 3 (25%) had small gastric varices.
Conclusions: EUS offers the most precise evaluation of portal hypertension in liver transplant candidates. "Deep", undetectable with routine endoscopy and potentially dangerous varices are noted in signifi cant proportion of them. The role of EUS as a potential tool for prioritizing subjects for liver transplantation should be determined in a prospective study.

Keywords: Liver Transplantation

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358