الفهرس | Only 14 pages are availabe for public view |
Abstract In Egypt, oesophageal varices is the most common cause of upper gastrointestinal bleeding. They are one of the major complications of portal hypertension. Many procedures are used to diagnose oesophageal varices, upper endoscopy is still the most common method used in the diagnosis of oesophageal varices, this method can detect submucosal varices only, but give no idea about the perioesophageal varices. Yet, transoesophageal ultrasonography can detect both submucosal and perioesophageal varices, also, it permits follow up and monitoring the effect of sclerotherapy. In this study, the normal pattern of oesophageal wall by transoesophageal ultrasonography was demonstrated in four patients with normal endoscopic finding, this pattern is always seen consisting of five layers as described before. Twenty five patients with different grades of oesophageal varices (five patients with grade I, nine patients with grade II, six patients with grade III and five patients with grade IV) were examined by transoesophageal ultrasonography after geal ultrasonography -81- endoscopic examination. Transoesophademonstrated submucosal oesophageal varices in 19 out of 25 patient (76%) and peri-oesophageal varices in 21 out of 25 patient (84%). We also found that the diameter of endoscopic grade I oesophageal varices range frame 2 to 3 mm, and of endoscopic grade II oesophageal varices range frame 3 to 4 mm while both in grade III and IV they range from 4-7 mm i.e. by transoesophageal ultrasonography, we can not differentiate between endoscopic grade III and grade IV oesophageal varices. Five cases were examined by transoesophageal ultrasonography after endoscopic injection sclerotherapy to illustrate the pattern, patency of the venous system post sclerotherapy in correlation with the endoscopic findings. Endoscopy remains the most accurate technique for the assessment of the oesophageal varices. It is superior to the transoesophageal ultrasonography in detection and grading of oesophageal varices. This less accuracy of the transoesophageal ultrasonography than the upper endoscopy may be in part attributable to problems with focusing the ultrasound display and the compression of the varices by the water filled bal loon that cover the transducer tip. Furthermore, transoesophageal ultrasonography does not demonstrate the red colour sign which is an important endoscopic sign indicating an increased risk of bleeding. However, transoesophageal ultrasonography has an important role in detecting perioesophageal varices and to assess the efficiency of sclerotherapy. Trans oesophageal ultrasonography is still in its infancy. No other image technique surpass the capability of transoesophageal ultrasonography in analyzing the normal and disrupted oesophageal wall architecture, so for the learning curve of this novel technique has been rather difficult and tedious and will probably remain so as much study and much correlation between in vivo and in vitro findings before reasonable degree of expertise and mastery of this technique can be obtained. also, development of the ultrasound probe systems is not static. Modification of existing devices is ongoing as suggested by the clinical need and the evaluation of prototype instruments. Hopefully, these endeavors will result in instrument that are easy to use, with better image quality and most importantly provide clinical useful information |