Weilert Frank, Binmoeller Kenneth F
Department of Gastroenterology, Waikato Hospital, Pembroke Street, Hamilton 2001, New Zealand.
Interventional Endoscopy Services, California Pacific Medical Center, 2351 Clay Street, 6th Floor, San Francisco, CA 94115, USA.
Gastroenterol Clin North Am. 2014 Dec;43(4):807-18. doi: 10.1016/j.gtc.2014.08.010. Epub 2014 Sep 12.
Expert knowledge of endoscopic management of gastric varices is essential, as these occur in 20% of patients with portal hypertension. Bleeding is relatively uncommon, but carries significant mortality when this occurs. Inability to directly target intravascular injections and the potential complication related to glue embolization has resulted in the development of novel techniques. Direct visualization of the varix lumen using endoscopic ultrasound (EUS) allows targeted therapy of feeder vessels with real-time imaging. EUS-guided combination therapy with endovascular coiling and cyanoacrylate injections promise to provide reduced complication rates, increased obliteration of varices, and reduced long-term rebleeding rates.
精通胃静脉曲张的内镜治疗知识至关重要，因为在20%的门静脉高压患者中会出现胃静脉曲张。出血相对不常见，但一旦发生，死亡率很高。无法直接进行血管内注射以及与胶水栓塞相关的潜在并发症促使了新技术的发展。使用内镜超声（EUS）直接观察静脉曲张腔，可通过实时成像对供血血管进行靶向治疗。EUS引导下的血管内圈套术和氰基丙烯酸酯注射联合治疗有望降低并发症发生率，提高静脉曲张闭塞率，并降低长期再出血率。
