| Theme | Indications and Standards of Practice for Emergency Endoscopy | |
|---|---|---|
| Title | Current Status of Emergency Endoscopy for Esophagogastric Variceal Bleeding | |
| Publish Date | 2018/05 | |
| Author | Shinichi Nakamura | Department of Endoscopy, Tokyo Women's Medical University |
| Author | Maiko Kishino | Department of Endoscopy, Tokyo Women's Medical University |
| Author | Hirotaka Yamamoto | Department of Gastroenterology, Tokyo Women's Medical University |
| Author | Ayako Kobayashi | Department of Gastroenterology, Tokyo Women's Medical University |
| Author | Kana Yamamoto | Department of Gastroenterology, Tokyo Women's Medical University |
| Author | Katsutoshi Tokushige | Department of Gastroenterology, Tokyo Women's Medical University |
| [ Summary ] | Esophagogastric varices are a known manifestation of portal hypertension associated with liver cirrhosis. Esophagogastric varices can be managed using endoscopic treatment, interventional radiology techniques, or surgery; however, presently endoscopic therapy such as the use of endoscopic variceal ligation (EVL) or endoscopic injection sclerotherapy (EIS) remains the primary approach. Emergency endoscopy plays an important role in the diagnosis and treatment of esophagogastric variceal bleeding. EVL was introduced clinically by Stiegmann et al. in 1988 and has gained rapid acceptance because it is a simple procedure that is not associated with any risk of bleeding from a variceal puncture site or the adverse reactions that could occur with sclerotherapy. The introduction of EVL has allowed the implementation of prophylactic treatment and also simplified the process of achieving hemostasis in patients with bleeding varices. The EIS-intravariceal technique is being widely used in Japan over 30 years. EIS using 5 % ethanolamine oleate (5%EO) is highly effective to sclerose esophageal varices and the associated blood vessels. Endoscopists should also acquire skills relating to EIS to enable them to use this technique in difficult cases wherein EVL might not be possible. Endoscopic obliteration of varices using Histoacryl has been introduced clinically and is accepted as first-line treatment for gastric variceal bleeding. It is important to establish and promote the use of guidelines regarding a safe and standard technique. | |