Endoscopic Hemoclipping for Bleeding Gastric Varices

概要

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We evaluated the efficacy of endoscopic hemoclipping of bleeding gastric varices with regard to initial hemostasis. We reviewed 8 patients with bleeding gastric varices that were treated with endoscopic hemoclipping over a 9-year period. The clinical and endoscopic findings and the clinical courses were analyzed retrospectively. Initial hemostasis for gastric variceal bleeding was achieved with endoscopic hemoclipping in all 8 cases with no immediate postclipping hemostatic failure. Follow-up endoscopy one day after the initial hemostasis revealed no tissue injury at the gastric varices (such as ulceration around the hemoclips) . There was no significant decrease in Child-Pugh class after hemoclipping. In 5 cases, additional treatments were required to eradicate gastric varices after the initial hemostasis with hemoclipping : 4 cases were treated with balloon-occluded retrograde transvenous obliteration (B-RTO) and one case was treated with shunt-occluded endoscopic injection sclerotherapy. Three months after gastric variceal obliteration, endoscopic examinations revealed variceal eradication in all 5 cases. Endoscopic hemoclipping of bleeding gastric varices is a safe and efficient procedure to achieve initial hemostasis. B-RTO after initial hemostasis is an effective treatment for eradication of gastric varices.
昭和大学・昭和医学会の論文