| Theme |
Complications and their Managements for Gastrointestinal Endoscopy |
| Title |
Complications of EIS and EVL, and their Managements |
| Author |
Yasunao Miyamoto |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University |
| Author |
Kazuhiko Oho |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University |
| Author |
Yoshihiro Sakamoto |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University |
| Author |
Kenji Sakai |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University |
| Author |
Masafumi Kumamoto |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University |
| Author |
Chizuru Tayama |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University |
| Author |
Atsushi Toyonaga |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University |
| [ Summary ] |
In Japan, the incidence of esophageal and gastric varices is high and endoscopic treatment is widely performed. This has improved the prognosis for patients with portal hypertension. There are more complications with endoscopic injection sclerotherapy (EIS) compared to endoscopic variceal ligation (EVL). Furthermore, those complications are often serious, such as bleeding or perforation of a puncture site, along with thrombosis and renal insufficiency caused by sclerosant. Moreover, strictures in the esophagus, related to EIS, reduce the patient's QOL. On the other hand, there are peculiar complications in EVL, such as perforation or injury to the pharynx and esophagus, related to overtube insertion. For prevention of these complications, it is important to evaluate the patient's condition and portal hemodynamics before the treatment. Caution is especially necessary for the diagnosis of pipe-line varix, solitary fundal varices, A-P shunts, portal vein tumor thrombosis, and porto-pulmonary venous anastomosis. In cases of heavy bleeding from varices, achievement of hemostasis is the primary goal. Additional treatment should be performed following improvements in the patient's general condition. In elective and the prophylactic treatment, we should choose the treatment option thought to have the lowest risk and the greatest expected permanent effect. |