الفهرس 
ANATOMY
Venous Drainage of the OesophagusOnly 14 pages are availabe for public view
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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
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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