Objective  Develop a 3D visualization endoscopic navigation system based on CT portal angiography (CTPA) and explore its clinical value in assisting precise treatment of esophageal and gastric varices (EGV).

Methods  Patients with EGV needing treatment in the Department of Gastroenterology of Zhongshan Hospital, Fudan University from September 2021 to April 2023 were collected. Preoperative examinations including CTPA and hematological examinations were performed, and a 3D visualization endoscopic navigation system was developed to assist endoscopic treatment. Real time comparison is made between the endoscopic 3D portal vein system image reconstructed by intelligent imaging and the actual endoscopic observation of the vascular morphology inside the cavity. The responsible blood vessels that are prone to bleeding are embolized using a sandwich injection method of “poly (cinnamyl alcohol)+tissue glue+poly (cinnamyl alcohol)”. For patients with portal shunting, ultrasound-guided coil insertion is performed. Postoperative endoscopic ultrasound or CTPA reexamination to evaluate vascular embolism and complications.

Results  A total of 13 patients successfully underwent endoscopic ultrasound-guided variceal embolization. The average maximum inner diameter of target veins was (3.3 \pm 1.3) cm; on average, one coil was implanted in each patient , with median dosages of lauromacrogol and adhesive glue were 9.5(7.8,10.0) mL and 1.5(1.0,2.1) mL respectively. Postoperatively, endoscopic ultrasound detecting confirmed complete occlusion of all target veins. At 8 weeks after treatment, none of the patients experienced rebleeding. At 24 weeks after treatment, rebleeding occurred in 3 patients, on postoperative days 107, 126 and 147, respectively.

Conclusion The 3D visualization endoscopic navigation system based on CTPA can effectively and safely assist preoperative diagnosis and intraoperative localization of target blood vessels, which is beneficial for the precise treatment of EGV patients.