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Background: Endoscopic Variceal Ligation (EVL) is a widely used and accepted prophylactic treatment for esophageal varices (EV)Θ. EVL is often associated with early recurrence of EV, but the recurrence rate appeared to be decreased by repeated endoscopic treatment. However, the hemodynamic changes associated with recurrent EVL treatment are poorly understood. Aim: To analyze changes of hemodynamics and anatomy of LGV caused by the endoscopic treatment for EV. Methods: 48 patients (Pts) with with cirrhosis (Group A: 18 Pts had >1 year follow up after eradication of EV: Group B: 30 Pts with no previous variceal treatment) were enrolled in this study.We used curved linear array echoendoscope (Pentax FG36UX) and Processing Unit (Hitachi EUB655). We analyzed 1) The diameter and blood velocity of trunks of LGV 2) Type of branches of LGV 3) The size of paraesophageal vein (PEV) 4)The detection rate of perforating vein (PV). We classified the types of branches into three groups; Type AD (anterior branch dominant), Type B (bilateral), Type PD (posterior branch dominant).We classified the size of PEV into four grades; Grade 1 (<2mm), Grade 2 (≥2 and <4mm), Grade 3 (≥4 and <6mm), Grade 4 (≥6mm). Results: LGV was visualized in all cases. The LGV bifurcated into anterior and posterior branches at the upper part of the stomach in all cases. The anterior branch was connected with EV. The posterior branch was connected with PEV. The PEV was connected with EV through the PV. The blood velocity was measured in 12/18 of Group A and 21/30 from Group B. 1) The diameters of LGV in Group A and B were 6.0±2.9, 4.7±2.2mm (p=0.062) The velocity of LGV in Group A and B were 11.0±6.7, 11.8±4.6cm/sec. (p=0.69) 2) Type PD was found in 9/17 patients from Group A and 3/27 patients from Group B. (p=0.0045) 3) The grades of PEV in Group A and B were 2.8±1.6, 1.7±0.7 (p=0.02) 4) The detection rate of perforating vein was significantly lower in Groups A (2/18 vs. 13/30 p=0.001). Conclusions: 1) Endoscopic variceal treatment appears to alter the distribution of LGV branches and collateral circulation of EV. 2) These novel findings suggest that anterior branch dominant system might be associated with early EV recurrence and that posterior branch dominant system with large PEV as an extravariceal shunt might be associated with reduced EV recurrence.