臨牀消化器内科 Vol.32 No.3(7)


特集名 消化管出血に対する診療―JGESガイドラインをふまえて
題名 静脈瘤出血へのアプローチ
発刊年月 2017年 03月
著者 渡辺 晃 福島県立医科大学附属病院内視鏡診療部/福島県立医科大学医学部消化器内科学講座
著者 引地 拓人 福島県立医科大学附属病院内視鏡診療部
著者 小原 勝敏 福島県立医科大学消化器内視鏡先端医療支援講座
著者 高木 忠之 福島県立医科大学医学部消化器内科学講座
著者 紺野 直紀 福島県立医科大学附属病院内視鏡診療部/福島県立医科大学医学部消化器内科学講座
著者 大平 弘正 福島県立医科大学医学部消化器内科学講座
【 要旨 】 肝硬変を主とする門脈圧亢進症患者は,食道・胃静脈瘤を高率に合併し,時に出血をきたす.食道・胃静脈瘤出血患者に遭遇した場合,まず呼吸循環動態を含めた全身管理を行った後に内視鏡的止血を行う.食道静脈瘤出血に対しては,内視鏡的静脈瘤結紮術(EVL)での一次止血を行い,後日,肝予備能に応じて内視鏡的硬化療法(EIS)またはEVLでの追加治療を行う.孤立性胃静脈瘤出血に対してはN‒butyl‒2‒cyanoacylateによる内視鏡的組織接着剤注入法で一次止血を行い,待期的にB‒RTO(バルーン下逆行性経静脈的塞栓術)や内視鏡治療を行う.
Theme Diagnoses & Treatments for Gastrointestinal Bleeding on the Basis of JGES Guidelines
Title Treatment for Variceal Bleeding
Author Ko Watanabe Department of Endoscopy, Fukushima Medical University Hospital / Department of Gastroenterology, Fukushima Medical University School of Medicine
Author Takuto Hikichi Department of Endoscopy, Fukushima Medical University Hospital
Author Katsutoshi Obara Department of Advanced Gastroenterological Endoscopy, Fukushima Medical University,
Author Tadayuki Takagi Department of Gastroenterology, Fukushima Medical University School of Medicine
Author Naoki Konno Department of Endoscopy, Fukushima Medical University Hospital / Department of Gastroenterology, Fukushima Medical University School of Medicine
Author Hiromasa Ohira Department of Gastroenterology, Fukushima Medical University School of Medicine
[ Summary ] Esophageal or gastric varices, which present a risk of bleeding, are often seen in patients with portal hypertension, which is mainly caused by liver cirrhosis.
For patients with esophageal or gastric variceal bleeding, endoscopic treatment can be performed after stabilization of respiratory and circulatory conditions. For cases of esophageal variceal bleeding, endoscopic variceal ligation (EVL) has been applied at the bleeding point. After initial hemostasis, additional endoscopic injection sclerotherapy or EVL can be performed depending on liver function. For cases of solitary gastric variceal bleeding, endoscopic therapy using N‒butyl‒2‒cyanoacrylate has been performed. After initial hemostasis, additional endoscopic therapy or balloon‒occluded retrograde transvenous obliteration has been performed.
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