Goff J S, Reveille R M, Van Stiegmann G
Division of Gastroenterology, University of Colorado Health Sciences Center, Denver.
Am J Gastroenterol. 1988 Nov;83(11):1240-4.
Endoscopic sclerotherapy is an effective method for treating bleeding esophageal varices. However, a number of complications may limit its usefulness. A newly developed method for treating bleeding varices, endoscopic variceal ligation, that uses small rubber bands to occlude and eradicate the varices, may cause less damage to the esophagus. Twenty-eight patients (seven with no prior treatment, eight undergoing sclerotherapy, and 12 undergoing variceal ligation) were evaluated with a symptom questionnaire and esophageal manometry. The lower esophageal sphincter (LES) pressures in the three groups did not differ. The percent LES relaxation was significantly (p = 0.04) less in the sclerotherapy group than in the untreated group. Contraction waves in the esophageal body were not different in amplitude, duration, and propagation speed in the three groups. There was no increase in the amount of heartburn after either form of treatment. Eight of the nine sclerotherapy patients had a stricture after treatment that required dilatation, whereas none of the ligation patients had strictures. We conclude from this that early in the course of sclerotherapy, stricture formation is common, but any long-lasting adverse effect on esophageal function is minimal. We also conclude variceal ligation therapy causes less esophageal dysfunction and has fewer local complications. Thus, endoscopic variceal ligation may be a safer and more easily tolerated alternative to endoscopic sclerotherapy.
内镜下硬化疗法是治疗食管静脉曲张出血的一种有效方法。然而，一些并发症可能会限制其应用。一种新开发的治疗静脉曲张出血的方法——内镜下静脉曲张套扎术，使用小橡皮筋来闭塞和根除静脉曲张，可能对食管造成的损伤较小。对28例患者（7例未接受过治疗，8例接受硬化疗法，12例接受静脉曲张套扎术）进行了症状问卷调查和食管测压评估。三组患者的食管下括约肌（LES）压力无差异。硬化疗法组的LES松弛百分比显著低于未治疗组（p = 0.04）。三组患者食管体部的收缩波在振幅、持续时间和传播速度方面无差异。两种治疗方式后烧心症状均未加重。9例接受硬化疗法的患者中有8例在治疗后出现狭窄，需要进行扩张，而接受套扎术的患者均未出现狭窄。由此我们得出结论，在硬化疗法早期，狭窄形成很常见，但对食管功能的任何长期不良影响都很小。我们还得出结论，静脉曲张套扎术导致的食管功能障碍较少，局部并发症也较少。因此，内镜下静脉曲张套扎术可能是一种比内镜下硬化疗法更安全、更容易耐受的替代方法。
