SELECTION OF APPROPRIATE TREATMENT FOR ESOPHAGO-GASTRIC VARICRES BY ENDOSCOPIC ULTRASONOGRAPHY
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概要
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We previously reported the usefulness of Endoscopic Ultrasonography (EUS) in selecting the optimal treatment methods for esophago-gastric varices on this Gastroenterol Endosc (1995 ; 37: 1838-49). We classified the vascular structure of esophago-gastric varices by EUS into a "typical pattern" and an "atypical pattern", and concluded the following; 1) The "typical pattern" cases, in which the maximum diameters of perforating veins (p. v.) are within 4mm, have indications for Endoscopic Injection sclerotherapy (EIS), while p. v. over 4mm should be treated with combined therapy. 2) The "atypical pattern" cases, in which the maximum diameters of p. v. are within 4mm, have indications for combined therapy, while p. v. over 4mm should be treated surgicaly or by Balloon occluded Retrograde Transvenous Obliteration (B-RTO). Conforming to this conclusion, we initiated prospective studies in 63 patients with esophago-gastric varices. In 37 cases (59%), structures were classified into the "typical pattern", and in 26 cases (41%) into the "atypical pattern". The "typical pattern" cases, in which the maximum diameters of p. v. are within 4mm, accounted for 35 cases. In two cases, p. v. diameters exceeded 4mm. The "atypical pattern" cases, in which the maximum diameters of p. v. are within 4mm, accounted for 16 cases. 10 cases had p. v. diameters exceeding 4mm. Based on these EUS findings, we selected EIS in 39 cases, combined therapy in 14 cases, and B-RTO in 10 cases. In all cases, whatever the treatment method, we had satisfactory results. Intramural vessels disapreared in all cases, and in 92% of the EIS cases, inflow vessels were thrombosed. We experienced no cases with severe complications using either treatment methods. EUS is useful for selecting safe and effective therapies for esophago-gastric varices.
- 社団法人 日本消化器内視鏡学会の論文
社団法人 日本消化器内視鏡学会 | 論文
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