Treatment of Esophagogastric Varices
Surgery for Organ Function and Biological Regulation, Nippon Medical School Graduate School of Medicine
Bleeding from esophagogastric varices is a catastrophic complication of chronic liver disease. We have been attempted surgery, embolization, and endoscopic treatment for the treatment of esophagogastric varices.
Endoscopic injection sclerotherapy (EIS) is an established treatment for esophageal varices. EIS is associated with a high incidence of local and systemic complications. Endoscopic variceal ligation (EVL) is increasingly used because of its safety and simplicity and because no sclerosant is used. Nevertheless, EVL is not always effective, and early recurrences have been reported. Furthermore, most patients with esophageal varices treated endoscopically require treatment for recurrent varices. We invented that EVL performed three times at bimonthly intervals. EVL performed at bimonthly intervals for the treatment of esophageal varices attained a higher complete eradication rate, a lower recurrence rate, and a lower additional treatment rate.
It is generally believed that bleeding from gastric varices is more severe than bleeding from esophageal varices, but bleeding from gastric varices occurs less commonly than from esophageal varices. The endoscopic risk factors for bleeding from esophageal varices include presence of raised red markings, cherry-red spots, blue color, and large size. However the risk factors for bleeding from gastric varices have yet to be characterized. Once gastric variceal hemorrhage did occur, bleeding from these varices was successfully stopped in all cases. Therefore, prophylactic treatment of gastric varices is not recommended.
ϊγεγο 2005; 1(4), 161-167
portal hypertension, esophagogastric varices, endoscopic treatment, embolization, operation
Hiroshi Yoshida, Department of Surgery 1, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan