Endoscopic signs of esophageal varicose veins

Varicose veins of the esophagus - this is an uneven expansion of esophageal venous trunks with the development of reactive changes in surrounding tissues. More often secondary and develop with portal hypertension, are caused by the formation of port-caval anastomoses. Oxygen starvation dramatically increases trophic disorders in the esophagus wall, which leads to the development of total esophagitis. The submucous location of the venous trunks contributes to their bulging into the lumen of the esophagus, the most pronounced changes in the lower third of the esophagus and in the cardial section, where the venous trunks are subepithelial. When examined against the background of mucosal inflammation, varicose veins look like blue cords. Number of trunks 1-4.

Classification by morphofunctional changes.

• I stage. The veins are small in caliber, unevenly widened, located in the thickness of the wall of the lower third of the esophagus. Diameter up to 2 mm. Peristalsis, mucous is not changed. Cardia closes.
• II stage. Caliber of veins up to 3-4 mm. They are located in the lower third and often in the middle third. Peristalsis preserved. Cardia is normal or gaping. Mucous with the phenomena of superficial inflammation or atrophy.
• III stage. The diameter of the veins is up to 10-15 mm. The veins are convoluted, there may be varicose nodules, located in the lower and middle third, partially shifting to the upper third. Peristalsis sluggish. Cardia gaping. Mucous thinned, hyperemic, there may be ulceration of varicose veins. Pronounced atrophic esophagitis, narrowing of the esophagus by 1/2.
• IV stage. Broadly protruding into the lumen of the esophagus is a conglomerate of strongly convoluted vessels that cover the entire esophagus and cardiac compartment. Peristalsis absent, cardia gaping. In the distal departments there are many erosions, often in the form of a chain. When biopsy - severe atrophic esophagitis. The lumen of the esophagus narrows to 1/3.

Among the complications, the most frequent is bleeding. At primary bleeding lethality - 40-50%, at relapse - up to 80%.

Criteria for distinguishing varicose veins from hypertrophic folds of the esophagus

1. The veins are usually nodular, the diameter towards the cardia increases, the color is gray or blue. When inflated by air do not subside. With instrumental palpation, resistance is determined.
2. The folds, in contrast to the veins, are relatively even, their caliber is the same throughout the course, they stop at the cardia. Their color is not different from the mucosa of the esophagus, the dentate line is preserved. With deep inspiration, the folds become smoother, and the veins become more visible.

[1], [2], [3], [4], [5]