Richard C K Wong1, Farees T Farooq, Amitabh Chak. 1. Division of Gastroenterology, Department of Medicine, University Hospitals Case Medical Center, 11100 Eucl;id Avenue, Cleveland, OH 44106, USA.
Abstract
BACKGROUND: Gastric varices may appear similar to enlarged gastric folds and submucosal neoplasms at endoscopy. A simple endoscopic method to diagnose variceal blood flow without formal EUS could be clinically useful. OBJECTIVE: To demonstrate the use of Doppler US (DOP-US) in the diagnosis of gastric varices. DESIGN: Case series. SETTING: A tertiary-care U.S. academic medical center. PATIENTS: Eight patients with findings of gastric submucosal lesions of uncertain etiology on EGD. INTERVENTIONS: EGD with DOP-US examination, with or without standard EUS. MAIN OUTCOME MEASUREMENTS: Presence or absence of audible DOP-US signal and EUS findings for gastric submucosal lesions. RESULTS: DOP-US demonstrated a reproducible continuous venous hum in 5 cases of gastric varices (confirmed by EUS in 2 cases). A sixth case of gastric varices demonstrated pulsatile flow with DOP-US (confirmed by EUS). In 1 case of a GI stromal tumor (GIST) in the stomach, no signal was heard when the lesion itself was examined by DOP-US. In a final case of Menetrier's disease, no signal was heard when the giant gastric folds were examined. CONCLUSIONS: DOP-US can help differentiate gastric varices from other gastric submucosal lesions. The use of DOP-US may obviate the need for EUS to confirm gastric varices when the EGD diagnosis is uncertain.
BACKGROUND: Gastric varices may appear similar to enlarged gastric folds and submucosal neoplasms at endoscopy. A simple endoscopic method to diagnose variceal blood flow without formal EUS could be clinically useful. OBJECTIVE: To demonstrate the use of Doppler US (DOP-US) in the diagnosis of gastric varices. DESIGN: Case series. SETTING: A tertiary-care U.S. academic medical center. PATIENTS: Eight patients with findings of gastric submucosal lesions of uncertain etiology on EGD. INTERVENTIONS: EGD with DOP-US examination, with or without standard EUS. MAIN OUTCOME MEASUREMENTS: Presence or absence of audible DOP-US signal and EUS findings for gastric submucosal lesions. RESULTS: DOP-US demonstrated a reproducible continuous venous hum in 5 cases of gastric varices (confirmed by EUS in 2 cases). A sixth case of gastric varices demonstrated pulsatile flow with DOP-US (confirmed by EUS). In 1 case of a GI stromal tumor (GIST) in the stomach, no signal was heard when the lesion itself was examined by DOP-US. In a final case of Menetrier's disease, no signal was heard when the giant gastric folds were examined. CONCLUSIONS: DOP-US can help differentiate gastric varices from other gastric submucosal lesions. The use of DOP-US may obviate the need for EUS to confirm gastric varices when the EGD diagnosis is uncertain.
Authors: Tom D Catron; George B Smallfield; Le Kang; Richard K Sterling; Mohammad S Siddiqui Journal: Dig Dis Sci Date: 2017-07-12 Impact factor: 3.199