Yoshida Hiroshi, Tajiri Takashi, Mamada Yasuhiro, Taniai Nobuhiko, Hirakata Atsushi, Kawano Youichi, Mizuguchi Yoshiaki, Shimizu Tetsuya, Takahashi Tsubasa
First Department of Surgery, Nippon Medical School, Tokyo, Japan.
Hepatogastroenterology. 2004 Mar-Apr;51(56):457-61.
BACKGROUND/AIMS: The characteristics of recurrent esophageal varices after endoscopic variceal ligation (EVL) plus endoscopic injection sclerotherapy (EIS) versus EVL alone, including the number of additional treatments and patterns of recurrence have been compared.
Thirty-four patients with cirrhosis and esophageal varices were treated by EVL alone (EVL group), and 46 patients were treated by EVL followed by extravariceal injection sclerotherapy (EVL+extraEIS group).
Fewer treatment sessions were needed (p<0.005), and more O-rings were required (p<0.0001) in the EVL group than in the EVL+extraEIS group. The 1- and 3-year cumulative recurrence rates were higher in the EVL group (81.3% and 93.8%) than in the EVL+extraEIS group (62.8% and 91.5%) (p<0.05). Endoscopic examination at first recurrence showed varices of a more severe form (p<0.001), but less frequently having the red color sign (p<0.0001), and intramucosal venous dilatation (p<0.0001) in the EVL group than in the EVL+extraEIS group. The number of rehospitalizations for additional treatment was lower (p<0.0001) and more patients could be managed with only endoscopic treatment for recurrent varices in the EVL group than in the EVL+extraEIS group (p<0.05).
Even if the overall rate of variceal recurrence was higher, fewer treatment sessions were needed, and the number of rehospitalizations for these additional treatments was lower in the EVL group than in the EVL+extraEIS group. Multiple sessions of EVL are an effective strategy for the treatment of esophageal varices.
背景/目的：比较内镜下静脉曲张套扎术（EVL）联合内镜注射硬化疗法（EIS）与单纯EVL术后复发性食管静脉曲张的特征，包括额外治疗次数和复发模式。
34例肝硬化合并食管静脉曲张患者接受单纯EVL治疗（EVL组），46例患者接受EVL后行曲张静脉外注射硬化疗法（EVL+曲张静脉外EIS组）。
与EVL+曲张静脉外EIS组相比，EVL组所需治疗次数更少（p<0.005），但需要更多的O形环（p<0.0001）。EVL组1年和3年累积复发率（81.3%和93.8%）高于EVL+曲张静脉外EIS组（62.8%和91.5%）（p<0.05）。首次复发时的内镜检查显示，与EVL+曲张静脉外EIS组相比，EVL组静脉曲张程度更严重（p<0.001），但红色征出现频率更低（p<0.0001），黏膜内静脉扩张发生率更低（p<0.0001）。与EVL+曲张静脉外EIS组相比，EVL组因额外治疗再次住院的次数更低（p<0.0001），且更多复发性静脉曲张患者仅通过内镜治疗即可得到处理（p<0.05）。
即使EVL组静脉曲张复发的总体发生率更高，但与EVL+曲张静脉外EIS组相比，其所需治疗次数更少，因这些额外治疗再次住院的次数更低。多次EVL是治疗食管静脉曲张的有效策略。
