特集名 | 門脈圧亢進症の治療update | |
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題名 | 門脈圧亢進症に対する内視鏡治療 (1) 食道静脈瘤に対するEVL | |
発刊年月 | 2012年 02月 | |
著者 | 金澤 慶典 | 東京慈恵会医科大学内視鏡科 |
著者 | 今津 博雄 | 東京慈恵会医科大学内視鏡科 |
著者 | 森 直樹 | 東京慈恵会医科大学内視鏡科 |
著者 | 角谷 宏 | 東京慈恵会医科大学附属柏病院内視鏡部 |
著者 | 田尻 久雄 | 東京慈恵会医科大学消化器肝臓内科 |
【 要旨 】 | 内視鏡的静脈瘤結紮術(EVL)は,薬物療法や内視鏡的静脈瘤硬化療法(EIS)と同様に有効な治療法である.本稿では,食道静脈瘤の急性出血に対する治療法,一次出血並びに二次出血の予防法について,海外のEVL研究を中心に概説した. 欧米では,急性食道静脈瘤出血に対し,EVLがEISより有効であることが示されており,急性食道静脈瘤出血に対する内視鏡治療としてEVLが推奨されている.また,食道静脈瘤の一次出血並びに二次出血の予防についても,EVLとβブロッカーがほぼ同等の出血率・致死率・有害事象率であることが示されてきた. |
Theme | Treatment for Portal Hypertension : Update | |
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Title | Endoscopic Variceal Ligation for Esophageal Varices | |
Author | Keisuke Kanazawa | Department of Endoscopy, The Jikei University School of Medicine |
Author | Hiroo Imazu | Department of Endoscopy, The Jikei University School of Medicine |
Author | Naoki Mori | Department of Endoscopy, The Jikei University School of Medicine |
Author | Hiroshi Kakutani | Department of Endoscopy, The Jikei University Kashiwa Hospital |
Author | Hisao Tajiri | Department of Gastroenterology and Hepatology, The Jikei University School of Medicine |
[ Summary ] | We review literature concerning endoscopic variceal ligation therapy (EVL) for esophageal varices employed in Western countries. Recent data suggest that EVL is superior to endoscopic injection sclerotherapy (EIS) for treatment of bleeding esophageal varices. Therefore, AASLD practice guidelines recommend EVL for bleeding esophageal varices. However, EIS is recommended for patients when EVL is not technically feasible. Regarding the prevention of esophageal variceal hemorrhaging, some meta-analyses suggest that both EVL and nonselective β-blockers are effective in preventing first and second variceal hemorrhaging. These studies showed that post-EVL outcomes, including rebleeding rates, mortality, and adverse event rates, did not differ significantly from those observed with medication therapy. Moreover, the combination of pharmacological and endoscopic therapy for prevention of variceal bleeding has been investigated intensively. Although β-blockers are still applied as a primary and secondary prophylaxis for first-line treatment in Western coutries, EVL is a valid option for the management of varices and variceal hemorrhaging. |