超声内镜在门脉高压所致食管胃底静脉曲张中的应用价值

Role of endoscopic ultrasound in patients with esophageal and gastric varices caused by portal hypertension

食管胃底静脉曲张(EGV)破裂出血严重威胁患者的生命安全,早期诊断并及时采取相应的治疗对改善患者的预后具有重大意义。超声内镜(EUS)将内镜和超声技术进行有机结合,为消化道疾病的诊治开辟了新的途径。EUS可显示胃食管黏膜下解剖结构、门静脉及其属支、食管周围侧支静脉和穿通静脉,协助EGV诊断、复发及再出血风险的评估,从而指导EGV临床诊治策略的制定;同时,还可通过钳道送入多种内镜附件,进行EUS引导硬化、组织胶栓塞及弹簧圈置入等多种介入治疗,可作为常规胃镜治疗失败及具有高异位栓塞风险患者的补充治疗手段。

Esophageal and gastric variceal bleeding is life threatening.Early diagnosis and timely medicaltreatment are vital in improving the prognosis of the patients.EUS is an organic combination of endoscopy and ultrasonography,while it starts a new era in diagnosis and treatment of gastrointestinal diseases.EUS can visualize the submucosalstructures of GI tract,portal vein and its branches,periesophageal collateral veins and large perforating veins.It has important roles in detection of varices and prediction of variceal bleeding,so as to guide and inform the development of diagnosis and treatment strategies for esophageal and gastric varices.Furthermore,therapeutic interventions such as EUS-guided sclerotherapy,cyanoacrylate injection,coil embolization can be performed rely on endoscopic accessories and interventional tools.EUS-guided hemostasis interventions can be used as a supplementary choice when conventional treatments failed,or to patients with high risk of distal embolization.