| 特集名 | 門脈圧亢進症の診断と治療 | |
|---|---|---|
| 題名 | 孤立性胃静脈瘤に対する予防的治療 (2) B-RTO,BES | |
| 発刊年月 | 2007年 05月 | |
| 著者 | 松本 章夫 | 久御山南病院内科 |
| 著者 | 滝本 見吾 | 武田総合病院消化器センター |
| 【 要旨 】 | 孤立性胃底部静脈瘤 (FV) を有する症例の門脈圧は低値であり，欧米において食道・胃静脈瘤治療の中心とされる減圧療法のtransjugular intrahepatic portosystemic shunt (TIPS) は無効であることが多い．本邦で開発されたballoon-occluded retrograde transvenous obliteration (B-RTO) は発達した門脈圧減圧路 (多くの場合胃腎短絡路) を有するFV症例に対する治療として近年急速に普及した．TIPSとB-RTOを含む経カテーテル的硬化療法との比較試験の成績からB-RTOの優位性が示され，今後世界的にB-RTOが予防的FV治療の第一選択となることが期待される．ただし，左胃静脈が供血するFVに関しては治療後の食道静脈瘤発生に留意が必要である． | |
| Theme | Diagnosis and Treatment of Portal Hypertention | |
|---|---|---|
| Title | Prophylactic Treatment for Isolated Gastric Fundal Varices -- B-RTO, BES | |
| Author | Akio Matsumoto | Department of Internal Medicine, Kumiyama Minami Hospital |
| Author | Kengo Takimoto | Department of Gastroenterology, Takeda General Hospital |
| [ Summary ] | It has been reported that esophageal varices rarely bleed when the portal pressure gradient (PPG) is < 12 mmHg. Transjugular intrahepatic portosystemic shunting (TIPS) is considered to be a second-line treatment for patients with gastroesophageal varices that are unresponsive to pharmacologic and endoscopic treatment. However, bleeding from isolated gastric fundal varices can occur even when the PPG is < 12 mmHg. Several reports showed that TIPS only improved the mortality rate in patients with bleeding at a PPG ≥ 12 mmHg. Balloon-occluded retrograde transvenous obliteration (B-RTO) is a new radiologic technique that was recently developed in Japan for the treatment of patients with isolated gastric fundal varices with a gastrorenal or a gastrophrenic shunt. B-RTO is similar to TIPS but is less invasive, and is technically easy for interventional radiologists to perform. In contrast, esophageal varices were likely to be worse after treatment with B-RTO because of elevations in portal pressure, which required treatment with endoscopic sclerotherapy. Partial splenic embolization can prevent the elevation of portal pressure after B-RTO. B-RTO is a recommended therapeutic option for the treatment of patients with isolated gastric fundal varices associated with a gastrorenal or gastrophrenic shunt, irrespective of the PPG or the shape or size of the varices. |
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