| Theme |
Diagnosis and Treatment of Portal Hypertention |
| Title |
Endoscopic Varicealography during Injection Sclerotherapy for Diagnosis and Treatment of Esophageal Varices |
| Author |
Fumio Chikamori |
Department of Digestive Surgery, Kunjyoshi Hospital |
| Author |
Nobutoshi Kuniyoshi |
Department of Internal Medicine, Kunjyoshi Hospital |
| Author |
Soichi Kagiyama |
Department of Internal Medicine, Kunjyoshi Hospital |
| Author |
Susumu Shibuya |
Department of Surgery, Tsukuba Soai Hospital |
| Author |
Takahiko Kawashima |
Department of Surgery, Tsukuba Soai Hospital |
| Author |
Yasuhiro Takase |
Department of Surgery, Tsukuba Soai Hospital |
| [ Summary ] |
Eradication of esophagogastric varices and diversion of portal blood flow to the extraluminal space is our strategy for treating varices. We found that the portal collateral system was divided into 2 sub-systems : the porto-azygos venous system and the porto-phrenic venous system. The former contributed to the formation of esophageal and cardiac varices, and the latter to the formation of isolated gastric varices located in the fundus, or in both the cardia and fundus. Endoscopic embolization (EE) can obliterate esophageal varices and their associated blood supply. However, flow in the extraesophageal veins is not controlled by EE, and these vessels are preserved. Injection of 5 % EOI under endoscopic varicealography encourages the formation of thrombi. Transjugular retrogarade obliteration for gastric varices is a treatment which diverts blood flow from the porto-phrenic venous system to the porto-azygos venous system. The occurrence of esophageal varices after TJO may be a disadvantage to patients, but esophageal varices can be treated easily with EE. Therefore, EE is a necessary adjunct to TJO. We believe that knowledge of the portal vascular anatomy and the effects of 5 % EOI contribute to the treatment of esophagogastric varices. |