| Theme |
Diagnosis and Treatment of Portal Hypertention |
| Title |
Sclerotherapy Combined with Drip Infusion of Vasopressin and Removal Technique for Injection Needle for Gastric Fundal Variceal Bleedings |
| Author |
Kuniyuki Kojima |
The third Depertment of Internal Medicine, Nara Medical University |
| Author |
Hiroo Imazu |
Depertment of Endoscopy, Jikei University School of Medicine |
| Author |
Masahiko Matsumura |
Depertment of General Medicine and Clinical Investigation, Nara Medical University |
| Author |
Tadao Mochi |
Depertment of Internal Medicine, Hattori Memorial Hospital |
| Author |
Hiroshi Fukui |
The third Depertment of Internal Medicine, Nara Medical University |
| [ Summary ] |
Most gastric fundal varices have a large gastrorenal shunt as the draining vein. Ruptures are often lethal because of the abundant blood flow. Although, cyanoacrylate (CA) injection therapy for gasric variceal bleeding has recently emerged as a first line therapy in Japan, Japanese insurance does not support the use of CA for treatment of varices. In addition the injection of CA into varices may lead to serious problems with multiple organ embolisms as a result of dispersion of CA into the systemic circulatory system. Conventional endoscopic sclerotherapy, using 5 % ethanolamine oleate (EO-EIS) has been reported to be ineffective for the treatment of gastric fundal varices. However, our EO-EIS method combined with drip infusion of vasopressin and a removal technique for injection needle may be effective for gastric fundal variceal bleeding without causing serious problems. Therefore, we recommend the EO-EIS method as an alternative to cyanoacrylate injection therapy for gastric variceal bleeding especially in situations where CA could not be used. |