内镜超声引导下圈套联合硬化剂治疗胃静脉曲张。

Endoscopic ultrasound-guided coil deployment with sclerotherapy for gastric varices.

机构信息

Department of Gastroenterology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa, Chiba, 272-8513, Japan.

Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan.

出版信息

Clin J Gastroenterol. 2021 Feb;14(1):76-83. doi: 10.1007/s12328-020-01259-5. Epub 2020 Oct 11.

DOI:10.1007/s12328-020-01259-5

PMID:33040299

Abstract

We present a case of gastric varices (GV) in the fundus treated by endoscopic ultrasound (EUS)-guided coil deployment with sclerotherapy. A 46-year-old man with a previous history of fatty liver and obesity presented to the emergency department with abdominal pain. Contrast computed tomography (CT) showed chronic liver disease, splenomegaly, and GV. Esophagogastroduodenoscopy (EGD) showed GV in the fundus. Follow-up EGD 6 months later revealed an increase in GV diameter to over 20 mm. Balloon-occluded retrograde transvenous obliteration appeared difficult due to the small caliber of the gastrorenal shunt observed on contrast CT. We performed EUS-guided coil deployment with sclerotherapy. The coil was deployed using a 19-gauge needle under EUS and fluoroscopic guidance. Next, 5% ethanolamine oleate with contrast medium was injected into GV using a 22-gauge needle. GV was reduced without complications, and no GV growth or hemorrhage was observed during 8 months of follow-up.

摘要

我们报告一例胃底静脉曲张（GV）经内镜超声（EUS）引导下线圈置入联合硬化剂治疗的病例。一名 46 岁男性，既往有脂肪肝和肥胖病史，因腹痛就诊于急诊科。对比增强计算机断层扫描（CT）显示慢性肝病、脾肿大和 GV。食管胃十二指肠镜（EGD）显示胃底 GV。6 个月后的随访 EGD 显示 GV 直径增加超过 20mm。由于对比 CT 观察到胃肾分流的小口径，球囊闭塞逆行经静脉闭塞术似乎难以进行。我们进行了 EUS 引导下的线圈置入联合硬化剂治疗。线圈在 EUS 和透视引导下使用 19 号针进行放置。然后，使用 22 号针将对比剂中的 5%乙醇胺油酸注入 GV。GV 得到缩小，且在 8 个月的随访中未观察到 GV 生长或出血。