小肠移植已经是治疗小肠不可逆性功能衰竭的有效手段，如果合并有小肠功能衰竭相关性肝脏疾病，则需要进行肝小肠联合移植。中等程度的肝硬化或者食管胃十二指肠内镜（OGD）检查发现食管胃底静脉曲张（GOV）是进行联合移植的指征。内镜下超声（EUS）是发现GOV的敏感方法。我们假设EUS能够发现早期GOV并能够减少肝脏活检的必要。16名儿童患者，平均年龄为13个月（范围为7-88个月）通过OGD和EUS评估了小肠移植。16名患者中有9名患者其OGD和EUS的结果一致，结果提示两者GOV均为阳性为2例，均为阴性为7例。其余7名患者仅仅EUS发现了GOV。这些病例中有4名患者进行了肝脏活检。因此，对于儿童小肠功能衰竭相关的肝脏疾病采用EUS检测GOV优于OGD，且需要肝脏活检的患者更少。

McKiernan PJ, Sharif K, Gupte GL.
Liver Unit, Birmingham Children's Hospital, Birmingham, United Kingdom.

Intestinal transplant is an established treatment of irreversible intestinal failure, unless complicated by advanced intestinal failure-associated liver disease, when liver-bowel transplant may be necessary. Finding at least moderate hepatic fibrosis or gastroesophageal varices (GOV) at oesophago-gastroduodenoscopy (OGD) has been an indication for combined transplantation. Endoscopic ultrasound (EUS) is a sensitive method for detection of GOV. We hypothesized that EUS would detect early GOV and decrease the need for liver biopsy. Sixteen children, median age 13 months (range, 7-88), being assessed for intestinal transplant underwent simultaneous OGD and EUS. In 9 of 16 patients the results of OGD and EUS were concordant, that is, both positive (2) or both negative (7) for GOV. In seven patients, GOV were only identified by EUS. Liver biopsy was avoided in four of these cases. EUS is superior to OGD for detecting GOV in children with intestinal failure-associated liver disease and results in fewer liver biopsies being necessary.