| Theme |
Diagnosis and Treatment of Portal Hypertention |
| Title |
Prophylactic Endoscopic Treatment for Isolated Gastric Varices Using Alfa-cyanoacrylate and Ethanolamine Oleate |
| Author |
Tadayuki Takagi |
Department of Internal Medicine II, Fukushima Medical University School of Medicine |
| Author |
Atsushi Irisawa |
Department of Internal Medicine II, Fukushima Medical University School of Medicine |
| Author |
Goro Shibukawa |
Department of Internal Medicine II, Fukushima Medical University School of Medicine |
| Author |
Katsutoshi Obara |
Department of Endoscopy, Fukushima Medical University Hospital |
| Author |
Hiromasa Ohira |
Department of Internal Medicine II, Fukushima Medical University School of Medicine |
| [ Summary ] |
Massive hemorrhaging from isolated gastric varices is a life threatening event. Recently, endoscopic treatment has become widely used and is associated with a good prognosis for gastric variceal bleeding. At this time, endoscopic treatment for gastric varices is performed not only for emergencies but also for prophylaxis, especially for treatment of risky varices, including those with positive red-color sign, erosion on the varices and / or large variceal form. We have selectively used two different types of therapeutic substances, tissue adhesive substances and sclerosants. The choice was made based on the rate of blood flow in the varices. Alfa-cyanoacrylate was used for gastric varices with relatively high rates of blood flow, and ethanolamine oleate was used for cases with relatively low rates of blood flow. The rate of blood flow was judged to be high or low by using negative or positive imaging, employing a contrast medium injected into the varices during X-ray fluoroscopy. The cumulative recurrent rate for our treatment is less than 10 %. Moreover, a low risk of aggravated esophageal varices after initial treatment for gastric varices has been demonstrated. In addition, an understanding of gastric variceal hemodynamics and therapeutic strategies is very important to obtain satisfactory therapeutic efficacy. |