| Theme |
Endoscopic Treatment of Upper Gastrointestine: Current Status and Clinical Problems |
| Title |
Progress in Endoscopic Management of Treatment Resistant Esophageal and Gastric Varices |
| Author |
Yasunao Miyamoto |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University, School of Medicine |
| Author |
Kazuhiko Oho |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University, School of Medicine |
| Author |
Yukihiko Morita |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University, School of Medicine |
| Author |
Yoshihiro Sakamoto |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University, School of Medicine |
| Author |
Masafumi Kumamoto |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University, School of Medicine |
| Author |
Atsushi Toyonaga |
The Second Department of Internal Medicine, Division of Gastroenterology and Endoscopy, Kurume University, School of Medicine |
| [ Summary ] |
Recently, pipe line varix (big tree-trunk type esophageal varix) and gastric fundal varices have been endoscopically treated safely and effectively with the development of new devices and skills, and with the introduction of tissue adhesive agents. At present, the key words for treatment-resistant varices are "extra-esophageal shunts" and "arterial blood inflow". When esophageal varices, with large extra-esophageal shunts, are treated with the endoscopic injection sclerotherapy, the sclerosant flows out into the systemic circulation. In addition, varices and inflowing veins cannot be obliterated. Sclerosant related complications, such as thrombosis, hepatic failure and renal dysfunction are likely to occur. Small cardiac varices with positive red color sign tend to recur repeatedly and may make it impossible to complete endoscopic treatment, because of difficulties with in intravariceal injection. It is suggested that a local hyperdynamic state in the upper gastric region may play some role in the recurrence of these varices. It is necessary to know the hemodynamic state of each case before treatment and to select the optimal treatment modality, including interventional radiology and/or surgical operations, depending on which hemodynamic abnormalities are observed. |