孤立性胃静脈瘤に対する内視鏡的硬化療法

Abstract

The author designed a direct injection method of endoscopic injection sclerotherapy (EIS) for solitary gastric varices and here reports its methodology and efficacy. The subjects studied were 105 patients with solitary gastric varices. Sixty-seven of them were treated with EIS and 38 were observed without EIS. The sclerosant, 5% ethanolamine oleate containing Iopamidol, was directly injected to the varices under X-ray monitoring. The author developed techniques to improve retention of the sclerosant and to minimize bleeding at the puncture site. Efficacy of EIS could be evaluated 1 to 3 months later in 61 cases. The gastric varices disappeared by the EIS in 40 of 61 patients (65.6%) and did not change in only 1 patient. In patients with bleeding varices, rate of hemostasis was higher and cumulative rates of re-bleeding, bleeding deaths and mortality rate were lower in patients with EIS than those with conservative treatment. In patients with non- bleeding F₂ and F₃ varices, cumulative rates of bleeding, bleeding deaths and mortality rate were also lower in patients with EIS than those with conservative treatment. Multivariate analysis by the multiple logistic model revealed that high Child grading, loss of EIS and bleeding on admission were significant factors for poor prognosis indicating bleeding and death within 1 year. Angiography showed that the varices and feeding vessels disappeared in almost all cases, but the drainage vessels were left in half the cases after EIS. As complications, mild shock, pleural effusion and ascites were observed in a few cases. No other serious complications were observed. The present study suggests that this direct injection method of EIS is an effective treatment to control and prevent bleeding from gastric varices.