内镜下注射硬化疗法治疗食管静脉曲张后门静脉高压性肠病加重。

Exacerbation of Portal Hypertensive Enteropathy after Endoscopic Injection Sclerotherapy for Esophageal Varices.

机构信息

Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan.

Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan,

出版信息

Digestion. 2021;102(2):188-196. doi: 10.1159/000503060. Epub 2019 Oct 1.

DOI:10.1159/000503060

PMID:31574519

Abstract

INTRODUCTION

Portal hypertensive enteropathy (PHE) is a well-known small-bowel lesion that occurs with liver cirrhosis (LC) and is associated with increased hepatic venous pressure. However, it is unclear how esophageal varices (EV) treatment actually affects PHE. We aimed to analyze the effects of EV treatment on PHE.

METHODS

Among LC patients who underwent capsule endoscopy (CE) more than twice to confirm PHE at our hospital from February 2009 to September 2018, we targeted those with no change in the Child-Pugh classification after EV treatment for the prevention of bleeding. Patients were assigned to groups based on the EV treatment method (endoscopic injection sclerotherapy [EIS] group or endoscopic variceal ligation [EVL] group). We analyzed the PHE findings before and after treatment, and we investigated changes in the collateral vein using computed tomography imaging.

RESULTS

We analyzed 42 LC patients (27 men; mean age, 65.3 years); 20 were in the EIS group and 22 were in the EVL group. Exacerbation of PHE was significantly prevalent in the EIS group (90%) compared to that in the EVL group (50%). CE of PHE showed significantly prevalent exacerbation of villous edema in the EIS group (65%) compared to that in the EVL group (23%). Stenosis or disappearance of the feeding vessel (55%) and exacerbation of the hepatofugal collateral vein (35%) were significantly prevalent in the EIS group.

CONCLUSIONS

EIS exacerbates PHE, especially villous edema, in LC patients with changes in collateral circulation.

摘要

简介

门脉高压性肠病（PHE）是一种众所周知的小肠病变，发生于肝硬化（LC），并与肝静脉压力升高有关。然而，食管静脉曲张（EV）的治疗如何影响 PHE 尚不清楚。我们旨在分析 EV 治疗对 PHE 的影响。

方法

在 2009 年 2 月至 2018 年 9 月期间，我院对超过 2 次进行胶囊内镜（CE）以确认 PHE 的 LC 患者进行研究，针对 EV 治疗以预防出血后 Child-Pugh 分类无变化的患者。根据 EV 治疗方法（内镜注射硬化疗法[EIS]组或内镜静脉曲张结扎术[EVL]组）将患者分为两组。我们分析了治疗前后的 PHE 发现，并使用计算机断层成像研究了侧支静脉的变化。

结果

我们分析了 42 例 LC 患者（27 名男性；平均年龄 65.3 岁）；20 例患者在 EIS 组，22 例患者在 EVL 组。与 EVL 组（50%）相比，EIS 组 PHE 恶化更为常见（90%）。EIS 组 CE 显示绒毛水肿恶化更为常见（65%），而 EVL 组则为（23%）。EIS 组的喂养血管狭窄或消失（55%）和向肝侧支静脉的恶化（35%）更为常见。