| Objective:To evaluate the value of endoscopic ultrasound(EUS)in the prevention and treatment of esophageal varices in patients with liver cirrhosis by analyzing the correlation between the prevention and treatment methods of esophageal varices and the results of EUS examination.Methods:Patients with cirrhotic varicose veins who had been diagnosed by endoscopy and completed ultrasonic endoscopy in the outpatient department of Gastroenterology of Jiangsu Subei People’s Hospital from July 2021 to December 2022 were analyzed.The gender,age of the study subjects,etiology,liver function,treatment for varicose veins,results of ordinary endoscopy and endoscopic ultrasound were collected from eligible research subjects,and ordinary endoscopy and ultrasonography were performed at the same time,and the examination results were recorded.Subjects were divided into groups according to whether they took NSBB or not and whether they had undergone ligation of esophageal varices.Measurement data were expressed as mean ±standard deviation(x±s),and t-test was used for comparison between two groups.Analysis of variance is used for three groups with equal variances,and the KruskalWallis H test is used for groups with unequal variances.Enumeration data are expressed in[n(%)],and Fisher’s exact test was used for comparison between groups.Kendall’s tau-b correlation coefficient was used to analyze the relationship between different measurement indicators under endoscopic ultrasonography and the relationship with treatment methods,and the variables with statistical significance were selected according to the results of univariate analysis and entered into linear regression analysis.Results:1.A total of 28 subjects with liver cirrhosis and esophageal and gastric varices were included.Among all the subjects,15 subjects(53.57%)took NSBB orally to treat varices,and 13 subjects(46.43%)did not take NSBB to treat varices.The type of drug used by all subjects taking NSBB was carvedilol,and the dose was(11.00±4.31)mg;among all subjects,24(85.71%)had undergone ligation of varices,A total of 4 people(14.29%)had never received ligation of varices.The total number of ligation rings for all subjects who underwent ligation was(6.83±2.91)rings.2.Among all the subjects,the maximum diameter of peri-esophageal collateral vessels(Peri-ECV)was(4.08±2.09)mm,the number of Peri-ECVs was(3.46±1.93),and the maximum diameter of the para-esophageal collateral Vessels(Para-ECV)was(6.94±3.23)mm,and the number of Para-ECV is(4.57±2.49).There were 16 subjects(57.14%)with perforator veins,and 12 subjects(42.86%)without perforator veins.The Kendall’s tau-b correlation coefficient was used to evaluate the correlations between various ultrasound measurements.There was a moderate positive correlation between the maximum diameter of Peri-ECV and the number of Peri-ECV(Kendall’s tau-b=0.483,P=0.024),a moderate positive correlation between the maximum diameter of Peri-ECV and the presence or absence of perforating branch veins(Kendall’s tau-b=0.569,P=0.017),and a moderate positive correlation between the number of Peri-ECV and the presence or absence of perforating branch veins(Kendall’s tau-b=0.670,P=0.007),while there were no significant correlations between other parameters(P>0.05 for all).3.Among all the subjects,for the subjects with esophageal and gastric varices detected by conventional endoscopy,the varicose veins were located in the esophagus,the maximum diameter of varicose veins was(6.42±1.95)mm,and the number of varicose veins was(1.29±0.62).Two study subjects(8.33%)had red signs,while 22 study subjects(91.67%)did not have red signs.The varices were linear in shape in 5 study subjects(20.83%),serpentine/sausage-like in shape in 16 study subjects(66.67%),and bead/nodular/tumor-like in shape in 3 study subjects(12.5%).No thrombosis was found in any of the study subjects.According to the LDRf classification method,5 study subjects(20.83%)were classified as mild,15 study subjects(62.50%)as moderate,and 4 study subjects(16.67%)as severe.4.Among all the subjects,15(53.57%)were in the oral NSBB group and 13(46.43%)were in the non-oral NSBB group.The mean age difference between the two groups(54.07±11.63 vs 63.54±12.06,t=-2.107,P=0.044)and the difference in total bilirubin level(28.37±14.02 vs 18.76±8.62,t=2.141,P=0.042)were statistically significant There were no statistically significant differences between the two groups in terms of gender,etiology of liver cirrhosis,albumin,PT prolongation time,Child classification,and ligation(P>0.05 for all).In general endoscopic examination,there were no significant differences in the position,maximum diameter,number,red sign,shape,thrombus and endoscopic grade of varicose veins between the oral NSBB group and the non-oral NSBB group(P>0.05 for all).In endoscopic ultrasonography,the largest diameter of Para-ECV in the oral NSBB group was significantly smaller than that in the non-oral NSBB group(5.77±2.61 vs 8.23±3.45),and the difference was statistically significant(P=0.03 8).There was no significant difference between the two groups in terms of the number of Para-ECVs and the presence or absence of perforating branch veins(P>0.05 for all).Among all the subjects in the study,24(85.71%)were in the ligation group and 4(14.29%)were not in the ligation group.There were statistical differences in albumin level(39.45±4.65 vs 45.55±5.74,t=-2.360,P=0.026)and PT prolongation time(2.09±2.16 vs-0.45±0.44,t=2.314,P=0.029)between the two groups There was no significant difference between the two groups in terms of gender,age,etiology of liver cirrhosis,total bilirubin,Child grade,and oral administration of NSBB(P>0.05 for all).In general endoscopic examination,there were no significant differences between the ligated group and the non-ligated group in terms of varicose vein location,maximum diameter,quantity,red sign,shape,thrombus and endoscopic grade(P>0.05 for all).In endoscopic ultrasonography,there was no significant difference between the ligation group and the non-ligation group in terms of the maximum diameter and number of Peri-ECV,the maximum diameter and number of Para-ECV,and the presence or absence of perforating branch veins between the two groups(P>0.05 for all).A total of 14 subjects who had undergone ligation of varices and whose esophageal varices were classified as intermediate under ordinary endoscopy were selected,and the average total number of ligation rings was(7.00±2.86)rings.The Kendall’s tau-b correlation coefficient was used to evaluate the relationship between the total number of ligation rings and the measurement indicators under endoscopic ultrasonography.There was a moderate positive correlation between the total number of ligation rings and the number of Peri-ECVs(Kendall’s tau-b=0.598,P=0.006)and a moderate positive correlation between the presence or absence of perforating branch veins(Kendall’s tau-b=0.560,P=0.019),while there were no significant correlations between the total number of ligation rings and other indicators(P>0.05 for all).Due to the correlation between the number of perforating branch veins and the number of PeriECVs,combined with professional knowledge,this study eliminated the parameter of whether there were perforating branch veins,and used a simple linear regression model to analyze the influence of the number of Peri-ECVs on the total number of ligation rings.Further linear regression analysis was performed on the number of Peri-ECVs and the total number of ligation rings,and the regression equation was:total number of ligation rings=3.310+(1.033×number of Peri-ECVs).The number of Peri-ECVs had a statistically significant effect on the total number of ligation rings(F=10.970,P=0.006).The number of Peri-ECVs explained 47.8%of the variation in the total number of ligation rings,with a moderate effect(adjusted R2=0.434).When the number of PeriECV increased by 1,the total number of ligation rings increased by 1.033(95%CI:0.354-1.713)rings.Conclusion:1.The results of endoscopic ultrasonography in patients with cirrhotic esophageal varices suggest that there are correlations between the maximum diameter of Peri-ECV and the number of Peri-ECVs,the maximum diameter of Peri-ECV and the presence or absence of perforating branch veins,and the number of Peri-ECVs and the presence or absence of perforating branch veins.2.The correlation between conventional endoscopy and endoscopic ultrasound examination results is not strong in treated patients with liver cirrhosis and esophageal varices.3.The benefits of oral non-selective beta-blocker(NSBB)treatment in patients with liver cirrhosis and esophageal varices cannot be evaluated well by conventional endoscopy,but changes in the maximum diameter of Para-esophageal collateral vessels can be detected by endoscopic ultrasound.Variceal ligation may affect the evaluation of disease status by conventional endoscopy,whereas endoscopic ultrasound can evaluate disease status based on the number of Peri-esophageal collateral vessels and the presence of perforating veins,and can predict to some extent the total number of rings needed for ligation treatment. |
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