Nakamura S, Mitsunaga A, Murata Y, Suzuki S, Hayashi N
Institute of Gastroenterology, Tokyo Women's Medical University, Japan.
Endoscopy. 2001 Mar;33(3):210-5. doi: 10.1055/s-2001-12804.
Esophageal varices are treated by endoscopic ligation with or without sclerotherapy. Here we used argon plasma coagulation (APC) to promote mucosal fibrosis and compared the efficacy of ligation plus APC with ligation alone in the treatment of esophageal varices.
Our prospective study included 30 patients with esophageal varices randomly assigned to receive APC after ligation (combined group) and 30 patients assigned to receive ligation only (ligation group). Endoscopic ligation was performed until the varix shrank to F1 without red color sign or smaller. This was followed by induction of fibrosis of the distal esophageal mucosa using APC in the combined group. APC was performed using an argon gas at a flow rate of 1.5-2 l/min and a high frequency arc output of 50-60 W. Treatment outcome and complications were compared between the two groups.
The mean follow-up time was 18.5+/-6.8 and 15.8+/-7.7 months (+/- SD) for the combined and ligation groups, respectively. The number of treatment sessions was slightly lower in the ligation group (2.9+/-0.6 vs. 2.5+/-0.6, P<0.05). The number of ligation bands used was not different between the two groups (13.4+/-3.1 vs. 14.9+/-2.4). The cumulative recurrence-free rate at 24 months after treatment in the combined group was significantly higher than in the ligation group (74.2% vs. 49.6%, P < 0.05). A significantly higher incidence of pyrexia was encountered in the combined group (P <0.05), but the incidences of other complications were similar in both groups.
Our results indicate that endoscopic ligation of esophageal varices combined with APC is superior to ligation alone. Since APC is theoretically well suited for mucosal fibrosis therapy, it can be used for the complete elimination of esophageal varices and for fibrosis of the distal esophageal mucosa.
食管静脉曲张可通过内镜下套扎术治疗，可联合或不联合硬化疗法。在此，我们使用氩等离子体凝固术（APC）促进黏膜纤维化，并比较套扎联合APC与单纯套扎治疗食管静脉曲张的疗效。
我们的前瞻性研究纳入了30例食管静脉曲张患者，随机分为套扎后接受APC治疗的联合组（30例）和仅接受套扎治疗的套扎组（30例）。进行内镜下套扎，直至静脉曲张缩小至F1级且无红色征或更小。联合组在此之后使用APC诱导食管远端黏膜纤维化。使用氩气以1.5 - 2升/分钟的流速和50 - 60瓦的高频电弧输出进行APC治疗。比较两组的治疗效果和并发症。
联合组和套扎组的平均随访时间分别为18.5±6.8个月和15.8±7.7个月（±标准差）。套扎组的治疗次数略少（2.9±0.6比2.5±0.6，P<0.05）。两组使用的套扎带数量无差异（13.4±3.1比14.9±2.4）。联合组治疗后24个月的累积无复发率显著高于套扎组（74.2%比49.6%，P<0.05）。联合组发热的发生率显著更高（P<0.05），但两组其他并发症的发生率相似。
我们的结果表明，食管静脉曲张内镜下套扎联合APC优于单纯套扎。由于APC理论上非常适合黏膜纤维化治疗，它可用于完全消除食管静脉曲张以及食管远端黏膜纤维化。
