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Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis.
Endoscopy. 2003 Nov; 35(11):940-5.E

Abstract

BACKGROUND AND STUDY AIMS

Endoscopic injection sclerotherapy (EIS) using cyanoacrylate and balloon-occluded retrograde transvenous obliteration (B-RTO) are the main procedures used to treat gastric varices. However, neither technique is free of problems. EIS for gastric varices may cause embolism in other organs; B-RTO requires a gastrorenal shunt and may aggravate esophageal varices. We have developed a combined form of endoscopic therapy involving band ligation and sclerotherapy which is an effective and safe procedure for treating gastric varices.

PATIENTS AND METHODS

Fifty-six patients with gastric varices and liver cirrhosis were treated at Almeida Memorial Hospital from June 1997 to May 2002 using the combined procedure. Each gastric varix was tightly ligated with O-rings, and 1 % polidocanol was injected into the submucosa around the ligated varix. If necessary, additional sclerotherapy was carried out after the initial treatment.

RESULTS

The rate of hemostasis for variceal bleeding was 100 %, and no critical complications were noted. Complete disappearance of the gastric varices was observed endoscopically in all cases. Computed tomography showed that collateral vessels outside the gastric wall were not occluded by the treatment. Endoscopic follow-up examinations were carried out, and gastric varices recurred in seven patients (12.5 %). Only two of the patients (3.6 %) had a small amount of oozing bleeding. Additional endoscopic variceal ligation (EVL) and/or EIS were performed in these seven cases, and none of the patients died as a result of a bleeding gastric varix.

CONCLUSIONS

The combined procedure was easily performed immediately after endoscopic examination, and required no special apparatus. It was found to be a safe and effective method of treating gastric varices.

Authors+Show Affiliations

Division of Gastroenterology, Almeida Memorial Hospital, Oita, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14606017

Citation

Arakaki, Y, et al. "Clinical Evaluation of Combined Endoscopic Variceal Ligation and Sclerotherapy of Gastric Varices in Liver Cirrhosis." Endoscopy, vol. 35, no. 11, 2003, pp. 940-5.
Arakaki Y, Murakami K, Takahashi K, et al. Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis. Endoscopy. 2003;35(11):940-5.
Arakaki, Y., Murakami, K., Takahashi, K., Sato, R., Okimoto, T., Ishitobi, H., Nasu, M., Kagawa, J., Kodama, M., & Fujioka, T. (2003). Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis. Endoscopy, 35(11), 940-5.
Arakaki Y, et al. Clinical Evaluation of Combined Endoscopic Variceal Ligation and Sclerotherapy of Gastric Varices in Liver Cirrhosis. Endoscopy. 2003;35(11):940-5. PubMed PMID: 14606017.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis. AU - Arakaki,Y, AU - Murakami,K, AU - Takahashi,K, AU - Sato,R, AU - Okimoto,T, AU - Ishitobi,H, AU - Nasu,M, AU - Kagawa,J, AU - Kodama,M, AU - Fujioka,T, PY - 2003/11/8/pubmed PY - 2004/3/9/medline PY - 2003/11/8/entrez SP - 940 EP - 5 JF - Endoscopy JO - Endoscopy VL - 35 IS - 11 N2 - BACKGROUND AND STUDY AIMS: Endoscopic injection sclerotherapy (EIS) using cyanoacrylate and balloon-occluded retrograde transvenous obliteration (B-RTO) are the main procedures used to treat gastric varices. However, neither technique is free of problems. EIS for gastric varices may cause embolism in other organs; B-RTO requires a gastrorenal shunt and may aggravate esophageal varices. We have developed a combined form of endoscopic therapy involving band ligation and sclerotherapy which is an effective and safe procedure for treating gastric varices. PATIENTS AND METHODS: Fifty-six patients with gastric varices and liver cirrhosis were treated at Almeida Memorial Hospital from June 1997 to May 2002 using the combined procedure. Each gastric varix was tightly ligated with O-rings, and 1 % polidocanol was injected into the submucosa around the ligated varix. If necessary, additional sclerotherapy was carried out after the initial treatment. RESULTS: The rate of hemostasis for variceal bleeding was 100 %, and no critical complications were noted. Complete disappearance of the gastric varices was observed endoscopically in all cases. Computed tomography showed that collateral vessels outside the gastric wall were not occluded by the treatment. Endoscopic follow-up examinations were carried out, and gastric varices recurred in seven patients (12.5 %). Only two of the patients (3.6 %) had a small amount of oozing bleeding. Additional endoscopic variceal ligation (EVL) and/or EIS were performed in these seven cases, and none of the patients died as a result of a bleeding gastric varix. CONCLUSIONS: The combined procedure was easily performed immediately after endoscopic examination, and required no special apparatus. It was found to be a safe and effective method of treating gastric varices. SN - 0013-726X UR - https://www.unboundmedicine.com/medline/citation/14606017/Clinical_evaluation_of_combined_endoscopic_variceal_ligation_and_sclerotherapy_of_gastric_varices_in_liver_cirrhosis_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2003-43475 DB - PRIME DP - Unbound Medicine ER -