| Theme | Diagnosis and Treatment of Portal Hypertention | |
|---|---|---|
| Title | EVL for Esophageal Varices -- Solution for Problems with EVL (Endoscopic Extensive Ligation ; EEL) | |
| Publish Date | 2007/05 | |
| Author | Kazuo Takahei | Division of Gastroenterology, Department of Internal Medicine, Yamatotakada Municipal Hospital |
| Author | Munechika Sasaoka | Division of Gastroenterology, Department of Internal Medicine, Yamatotakada Municipal Hospital |
| Author | Noriyuki Hamato | Division of Gastroenterology, Department of Internal Medicine, Yamatotakada Municipal Hospital |
| Author | Nobuyuki Ban | Division of Gastroenterology, Department of Internal Medicine, Yamatotakada Municipal Hospital |
| [ Summary ] | EVL, developed by Stiegmann, is advantageous in that it does not require the use of a sclerosant or a high level of skill. However, there have been many reports in Japan indicating a higher rate of short term variceal recurrence after EVL compared to sclerotherapy. At our institution, we have developed and performed a new technique called “Endoscopic Extensive Ligation (EEL)” and have obtained good results. In the first session, the lesion is ligated in the cardia at the level directly below the esophagogastric junction. Then, the lesion is ligated in the esophagogastric junction at the same level. Lastly, the lesion is tightly ligated in the lower to middle esophagus. After 2 weeks, the lesion is ligated again in the cardia at the same level between the scars resulting from the first session. Then, the lesion in the lower to middle esophagus is ligated tightly again. This results in the annular formation of fibrosis in the region ranging from the esophagogastric junction to the middle esophagus. EEL has significantly decreased the rates of variceal recurrence and rebleeding compared to standard EVL. |
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