Naritaka Yoshihiko, Shimakawa Takeshi, Isohata Noriyuki, Asaka Shinichi, Konno Souichi, Murayama Minoru, Yoshimatsu Kazuhiko, Shiozawa Shunichi, Katsube Takao, Ogawa Kenji
Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan.
Hepatogastroenterology. 2008 Nov-Dec;55(88):2096-102.
BACKGROUND/AIMS: Endoscopic injection sclerotherapy (EIS) has been extensively applied world wide. There are few reports, however, addressing the long-term prognosis (>20 years), although more than two decades have elapsed since the introduction of EIS for esophageal varices. Therefore, the cases of EIS performed in the past 25 years were reviewed to evaluate the long-term results of this procedure.
There were 602 patients who underwent EIS for esophageal varices between 1981 and 2005, involving a total of 1,964 applications of this procedure. The procedure begins by intravascular injection of 10-20 mL of 5% ethanolamine oleate. The long-term follow-up data were evaluated with primary reference to changes in esophageal varices, survival rate, bleeding rate, causes of death and re-bleeding.
In 188 patients with known final endoscopic findings, the gross morphologic status was F1 in 65 patients (34.6%) and F0 in 123 patients (65.4%), only 22 patients (11.7%) were positive for red color sign. The survival rate was 47.4% at 5 years, 25.9% at 10 years, and 13.9% at 15 years. Rebleeding occurred in 93 patients (15.4%). The bleeding rate was 22.9% at 5 years, 28.9% at 10 years, and 28.9% at 15 years. The causes of death were hepatic failure in 244 patients and hepatic cancer in 88 patients, 19 patients died as a result of bleeding from varices (4.8%), 3 patients who died due to therapeutic procedure of EIS.
Both the survival rate and rebleeding rate associated with EIS were comparable to those undergoing surgical treatment in patients whose clinical characteristics were matched. EIS is a minimally invasive treatment method that is considered to be an effective first-line treatment for esophageal varices.
背景/目的：内镜下注射硬化疗法（EIS）已在全球广泛应用。然而，尽管自EIS用于治疗食管静脉曲张已有二十多年，但关于其长期预后（>20年）的报道较少。因此，我们回顾了过去25年中进行EIS的病例，以评估该治疗方法的长期效果。
1981年至2005年间，共有602例患者接受了EIS治疗食管静脉曲张，共进行了1964次该治疗。治疗方法为血管内注射10 - 20 mL 5%油酸乙醇胺。长期随访数据主要根据食管静脉曲张的变化、生存率、出血率、死亡原因和再出血情况进行评估。
在188例有最终内镜检查结果的患者中，大体形态学状态为F1的有65例（34.6%），F0的有123例（65.4%），仅22例（11.7%）红色征阳性。5年生存率为47.4%，10年生存率为25.9%，15年生存率为13.9%。93例患者（15.4%）发生再出血。5年出血率为22.9%，10年出血率为28.9%，15年出血率为28.9%。死亡原因包括244例肝衰竭、88例肝癌、19例因静脉曲张出血死亡（4.8%）、3例因EIS治疗操作死亡。
在临床特征匹配的患者中，EIS的生存率和再出血率与手术治疗相当。EIS是一种微创治疗方法，被认为是食管静脉曲张的有效一线治疗方法。
