| Theme | Diagnosis and Treatment of Portal Hypertention | |
|---|---|---|
| Title | Treatment for Esophageal Gastric Varices in Japan -- Current Problem and Future Aspect | |
| Publish Date | 2007/05 | |
| Author | Hiroo Imazu | Department of Endoscopy, Jikei University School of Medicine |
| Author | Hisao Tajiri | Department of Endoscopy, Jikei University School of Medicine / Departmen of Gastroenterology and Hepatology, Jikei University School of Medicine |
| [ Summary ] | Concepts concerning methods of treatment for esophageal gastric varices in Japan are quite different from those in Western countries. In Western countries, β-blockers are the most popular as propylactic therapy for esophageal varices (EV), EVL is recommended as asecond-line therapy when β blockers have failed. However, prophylactic endoscopic treatments, including sclerotherapy and EVL, are the first line treatments for EV in Japan. Regarding gastric fundal varices (GV), cyanoacrylate (CA) obliteration therapy has commonly been performed for gastric fundal variceal bleeding both in Japan and in Western countries. Although prophylactic therapy for GV has never been done in Western contries, prophylactic B-RTO is now popular as a first line treatment for GV in Japan. Sclerotherapy under fluoroscopy and B-RTO have been developed in Japan. Most Japanese endoscopists are confident that sclerotherapy under fluoroscopic guidance is very usueful for high risk EV. However, this procedure has been performed only in Japan, and has never been accepted in other coutries, because there is less English literature concerning it. B-RTO is also unpopular in Western coutries because of a lack of evidence on its effectiveness for GV bleeding. Now, well designed prospective studies about Japanese sclerotherapy and B-RTO should be warranted in order to popularize these treatments world wide. |
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