Uno Kaname, Iijima Katsunori, Koike Tomoyuki, Abe Yasuhiko, Asano Naoki, Yokosawa Satoshi, Imatani Akira, Shimosegawa Tooru
Division of Gastroenterology, Tohoku University Hospital, Sendai, Miyagi, Japan.
Surg Laparosc Endosc Percutan Tech. 2012 Aug;22(4):e226-9. doi: 10.1097/SLE.0b013e318254d630.
Currently, there is little report of treatment strategy for early gastric cancer (EGC) on gastric fundal varices (GFVs), because controlling GFVs was more challenging than controlling gastric cardiac varices associated with esophageal varices. We first report effective endoscopic treatment of EGC on GFVs of a 77-year-old man with Child-B cirrhosis. Endoscopic ultrasound and multidetector-row computed tomography studies revealed intramucosal EGC on variceal components, supplied from posterior gastric vein and drained to subphrenic vein without gastrorenal shunt. With informed consent, we performed endoscopic submucosal dissection (ESD) after eradication of GFVs by endoscopic injection sclerotherapy (EIS). Histologic assessment revealed curability of ESD and inflammation and fibrosis around EIS site. Thereafter, no recurrence and complication had occurred. To avoid life-threatening bleeding from GFVs, we achieved complete resection by ESD under direct visualization of submucosa after eradication of GFVs by EIS based on the examination of hemodynamics and local relationship between EGC and GFVs.
目前，关于胃底静脉曲张（GFV）合并早期胃癌（EGC）的治疗策略报道较少，因为控制胃底静脉曲张比控制与食管静脉曲张相关的贲门静脉曲张更具挑战性。我们首次报道了对一名患有Child-B型肝硬化的77岁男性患者的胃底静脉曲张合并早期胃癌进行有效的内镜治疗。内镜超声和多层螺旋CT检查显示，病变位于静脉曲张部位的黏膜内，由胃后静脉供血，引流至膈下静脉，无胃肾分流。在获得患者知情同意后，我们在内镜注射硬化治疗（EIS）消除胃底静脉曲张后，进行了内镜黏膜下剥离术（ESD）。组织学评估显示ESD可治愈，且EIS部位周围有炎症和纤维化。此后，未发生复发和并发症。为避免胃底静脉曲张危及生命的出血，我们根据血流动力学检查以及早期胃癌与胃底静脉曲张的局部关系，在内镜注射硬化治疗消除胃底静脉曲张后，在内镜直视下对黏膜下层进行ESD，实现了完全切除。
