Esophageal varices:from vascular anatomic basis to endoscopic treatment
The normal anatomy of esophageal venous system is very complex,consisting of intrinsic veins and extrinsic veins.In the lower part of esophagus,according to the structural characteristics of esophageal veins,four distinct zones can be found:gastric zone,palisade zone,perforating zone and truncal zone.In terms of venous drainage,venous blood from the neck,chest,and abdominal esophagus drains into different veins.In portal hypertension,because of hepatofugal blood flow from veins such as left gastric vein,posterior gastric vein and short gastric vein,venous dilation in all layers occurs,especially deep intrinsic veins,leading to 3-4 endoscopically observed tortuous veins.Blood in varices can come from veins in gastric zone only,perforating vein only or from both.Endoscopic treatment of esophageal varices includes ligation and sclerotherapy,both of which have their own advantages and disadvantages.Familiarity with normal esophageal venous anatomy and drainage has important implications for understanding of varices formation,ectopic embolisation and personalized options of endoscopic treatment modality.
Esophageal varicesEndoscopic sclerotherapy for esophageal varicesEndoscopic ligation of esophageal varicesEsophageal vascular anatomy
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