特集名 | 門脈圧亢進症の診断と治療 | |
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題名 | 日本の食道・胃静脈瘤治療 -- 問題点と今後の展開 | |
発刊年月 | 2007年 05月 | |
著者 | 今津 博雄 | 東京慈恵会医科大学内視鏡科 |
著者 | 田尻 久雄 | 東京慈恵会医科大学内視鏡科/東京慈恵会医科大学消化器・肝臓内科 |
【 要旨 】 | わが国の食道・胃静脈瘤治療に対する考え方,方法は欧米諸国と異なっている.食道静脈瘤に対する予防治療に関してわが国では硬化療法を中心とした内視鏡的治療が盛んに行われているが,欧米ではβブロッカーが治療の中心である.胃静脈瘤出血に関しては日本を含むアジア,ヨーロッパを中心にcyanoacrylate系薬剤による内視鏡的塞栓療法が行われている.胃静脈瘤に対する予防治療に関しては日本ではballoon-occluded retrograde transvenous obliteration (B-RTO) が盛んであるが,胃静脈瘤に対する予防治療のエビデンスが乏しく,欧米では予防治療はほとんど行われていない. 透視下硬化療法とB-RTOは日本で開発され,発展してきた.しかし,これらの手技は欧米での認知度がきわめて低い.とくに透視下硬化療法は日本でのみ行われている手技といっても過言ではない.今後,これら日本の硬化療法,B-RTOを世界に発信していくために,正しいデザインによる前向き検討が望まれる. |
Theme | Diagnosis and Treatment of Portal Hypertention | |
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Title | Treatment for Esophageal Gastric Varices in Japan -- Current Problem and Future Aspect | |
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. |