LAUSR

Esophageal variceal recurrence after endoscopic treatment is a frequent event [1–4]. Some studies have reported that endoscopic treatment assisted by endoscopic ultrasonography (EUS) that can evaluate variceal size and hemodynamics is effective in preventing variceal recurrence [3, 4]. Additionally, color Doppler evaluation by EUS is less invasive and enables endoscopists to identify the varices to be treated [4]. However, the DopplerEUS method has issues related to its use: it is time-consuming, it is complicated to use convex transducers, and it requires scope replacement for additional treatment. The latest method, Doppler probe ultrasonography, uses a through-thescope Doppler probe (Compumedics, DWL, Singen, Germany) (▶Fig. 1 a) that can evaluate the direction, waveform (that helps distinguish between arteries and veins), and the amount of blood flow (▶Fig. 1b, c) [5]. Moreover, Doppler probe ultrasonography is simple, noninvasive, and requires no scope replacement for additional treatment. The procedure involves 1) identification of more risky varices, 2) detection of penetrating varices, 3) assisting appropriate hemostasis, and 4) evaluation after hemostatic treatment. Here we demonstrate two variceal treatments using this novel approach (▶Video 1). Case 1 involved a patient with a history of esophageal variceal rupture. Although he had undergone repeated endoscopic variceal ligations, recurrence of varices was observed (▶Fig. 2 a). We evaluated high-risk varices using Doppler probe ultrasonography (▶Fig. 2b). Because varices previously treated with endoscopic variceal ligation had a penetrating vein and massive blood flow, we performed an additional ligation at the site of vein penetration (▶Fig. 2 c). Varices were evaluated afterwards and the effectiveness of hemostasis was confirmed (▶Fig. 2d). Case 2 had a history of hemostasis for gastric variceal rupture (▶Fig. 3 a). Subsequently, esophageal varices developed. Esophageal varices continuous with the stomach were identified, and endoscopic variceal ligation was performed (▶Fig. 3 b). Both cases were treated effectively with endoscopic variceal ligation assisted by our novel Doppler probe ultrasonography. Endoscopy_UCTN_Code_TTT_1AO_2AD