| 特集名 | 門脈圧亢進症の診断と治療 | |
|---|---|---|
| 題名 | 食道静脈瘤に対するEVL -- 問題点と工夫 (endoscopic extensive ligation ; EEL) | |
| 発刊年月 | 2007年 05月 | |
| 著者 | 高幣 和郎 | 大和高田市立病院消化器内科 |
| 著者 | 笹岡 宗史 | 大和高田市立病院消化器内科 |
| 著者 | 濱戸 教行 | 大和高田市立病院消化器内科 |
| 著者 | 伴 信之 | 大和高田市立病院消化器内科 |
| 【 要旨 】 | endoscopic variceal ligation (EVL) は手技の簡便さとその止血，荒廃効果により欧米では高い評価を得ているが，早期の再発例や出血例が非常に多い問題点がある．しかし静脈瘤治療に熟練していない一般病院ではEVLを第一選択とすることが多く，endoscopic injection sclerotherapy (EIS) を第一選択としている施設でも，緊急例や肝機能，全身状態不良例などではEVLを選択している，そこでわれわれは，食道・胃接合部直下噴門より食道・胃接合部にかけて全周性に結紮術を施行し，かつ下部から中部食道に大量に同一平面上に結紮することにより，その部位に全周性の線維化を起こすことで再発を予防する，endoscopic extensive ligation (EEL) を考案し良好な成績をあげている． | |
| Theme | Diagnosis and Treatment of Portal Hypertention | |
|---|---|---|
| Title | EVL for Esophageal Varices -- Solution for Problems with EVL (Endoscopic Extensive Ligation ; EEL) | |
| 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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