Impact of endoscopic ultrasound examination for deep esophageal collateral veins evaluation in liver cirrhosis patients prior to endoscopic treatment: A case series

Aim:The presence of esophageal collateral veins (ECV) has been reported tobe associated with the recurrence of esophageal varices (EV) and bleeding inliver cirrhotic (LC) patients. This study aimed to see the potential clinicalvalue of deep collateral veins assessment using endoscopic ultrasound (EUS)in liver cirrhotic patients with EV. Methods:During 6 months period, a prospective study is conducted, wherewe identified LC patients who were admitted for esophagogastroduodeno-scopy (EGD) screening at the Department of Internal Medicine, Dr. CiptoMangunkusumo National General Hospital, Jakarta. ECV was examined usingEUS. Patients were excluded if they had (1) liver malignancy, (2) history ofligation or glue injection, or (3) portal or splenic vein thrombus. We collecteddemographic data, medical history, data pertaining to use of nonselectivebeta blocker (NSBB), and laboratory, imaging, and endoscopy results. EGDwas performed using a gastroscope (EG29‐i10, 3.2 mm Pentax Medical) whileEUS was performed using a linear array echoendoscope (EG‐3870UTK,3.8 mm, Pentax Medical) before band ligation or glue injection. Results:There were 20 LC patients included in this study, where 15 (75%) ofpatients were classified with Child–Pugh (CP)‐A andfive (25%) of patientswith CP‐B. The most common aetiologies were hepatitis B in seven (35%)patients and hepatitis C in nine (45%) patients. The EV with peri‐or para‐esophageal veins (PEEV or PAEV) were detected in 65% of patients. None ofthe LC patients with no EV showed the presence of ECV. PEEV or PAEV weredetected in grades 1–3 EV. Conclusion:EUS examination can give a better evaluation before managing gastroesophageal varices through deep ECV detection in LC patients.