What Are Esophageal Varices?

Esophageal varices are caused by obstruction of reflux in the esophagus or veins connected to the esophagus. The most common is lower esophageal varicose veins formed by portal hypertension, and the disease spreads upward, also known as ascending esophageal varices. In addition, mediastinal and neck diseases compress the superior vena cava and upper esophageal vein to prevent reflux, and the disease gradually spreads downward, which is called descending esophageal varices.

Esophageal varices are caused by obstruction of reflux in the esophagus or veins connected to the esophagus. The most common is lower esophageal varicose veins formed by portal hypertension, and the disease spreads upward, also known as ascending esophageal varices. In addition, mediastinal and neck diseases compress the superior vena cava and upper esophageal vein to prevent reflux, and the disease gradually spreads downward, which is called descending esophageal varices.
Chinese name
Esophageal varices
Foreign name
esophageal varices

Esophageal varices I. Etiology and related diseases

The main cause of esophageal varices is portal hypertension, and a few can be caused by obstruction of esophageal vein reflux caused by bronchial or esophageal cancer compressing the superior vena cava or cardiac cancer. For those with esophageal varices caused by portal hypertension, portal pressure generally exceeds 25-30 cm of water. The immediate cause of bleeding is esophagitis or sudden increase in pressure in the esophagus, occasionally due to trauma such as rough food. Hematemesis and / or black faeces are the main clinical manifestations of esophageal varices bleeding.

Esophageal varices 2. Differential diagnosis

X-ray barium meal examination and esophagoscopy are important methods for the diagnosis of esophageal varices. The scope and extent of varicose veins can be observed under esophagoscopy. Spleen-portal angiography, superior mesenteric arteriography, or umbilical-portal angiography all contribute to the diagnosis.
Early esophageal varices are not easy to detect. X-ray examination should pay attention to using medium viscosity barium sulfate paste. The Valsalva or Müller test (the first Valsalva test is appropriate) can be used when filming, and anti-acetylcholine drugs can be used for hypotonic esophageal photography to improve the display rate of early lesions. If the standing check is not certain, the observation in the supine position can be used. The X-ray showed esophageal mucosal folds widening, multiple small depressions on the uneven edges, or mild worm-like. These phenomena are most suitable for the mucosal phase when the esophagus is moderately contracted. In the later period, the continuity of the mucosal striae was lost, and beaded or dotted filling defects were formed. Extensive lesions may involve the full length of the esophagus, with obvious expansion of the esophagus, reduced peristalsis, and difficulty in contraction. There are numerous curved chain and earthworm-shaped filling defects in the esophagus cavity, and the edge of the esophagus is jagged. Most esophageal varices are at the lower end of the esophagus, and the cardia is occluded to varying degrees due to the protruding veins. There are even soft tissue masses in the cardia and the bottom of the stomach. Must be distinguished from esophageal tumors. The X-ray manifestations of descending esophageal varices are the same as those of ascending esophageal varices, except that the lesion begins at the upper part of the esophagus. It should be noted whether there are other primary lesions such as the mediastinal area.

Esophageal varices III. Treatment principles

Endoscopic esophageal varix ligation (EVL) is an important method for the treatment of EVB developed in the 1980s. It attaches the rubber ring to the front end of the endoscope and sucks the varicose vein negative pressure into the transparent cap. With rubber band ligation, the blood flow of varicose veins was interrupted by mechanical action, thrombus formation, and finally necrotic ulcers occurred, the remaining scars were healed, and the varicose veins disappeared.
Endoscopic injection scle-rotherapy (EIS) is an effective method for the treatment and prevention of rebleeding and elimination of varicose veins. After endoscopic varicel ligation (EVL), low-dose sclerotherapy can continue to dissipate residual esophageal varices after ligation, prevent recanalization of veins that have disappeared from occlusion, and prevent rebleeding, which can help improve the effectiveness of ligation. Long-term effect, delay the recurrence of varicose veins. In addition, most patients with acute bleeding have poor liver function and cannot tolerate surgical treatment. Sclerosing agent treatment can be used as an effective method for emergency hemostasis of varicose vein rupture and bleeding, and there are few complications. Therefore, it has won time for elective surgery and liver transplant opportunity. Sclerosing agents are a class of drugs that can cause significant local thrombosis, which in turn can cause inflammation, ulcers, and fibrosis, thereby effectively occluding varicose veins.

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