Chikamori Fumio, Kojima Koji, Uchita Kunihisa, Sharma Niranjan
Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi 780-8562, Kochi, Japan.
Department of Gastroenterology, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi 780-8562, Kochi, Japan.
Radiol Case Rep. 2023 Apr 19;18(6):2282-2288. doi: 10.1016/j.radcr.2023.03.037. eCollection 2023 Jun.
A case of high-risk giant esophagogastric varices was treated by blood supply route-targeted endoscopic injection sclerotherapy with multiple ligations (EISML). An endoscope was inserted in the left lower semi-lateral position under general anesthesia in the digital subtraction angiography room. The C-arm was rotated to obtain a frontal view for fluoroscopy. Before puncturing the esophageal varices, the balloon attached to the tip of the endoscope was inflated to block the variceal blood flow. At puncture, an intravascular injection was confirmed fluoroscopically, and a total of 18 m of 5% ethanolamine oleate with iopamidol was injected retrogradely at 5-minute intervals from the esophagogastric varices to the root of the left gastric vein, maintaining stagnation for 25 minutes. The variceal site of the injection was ligated immediately after the removal of the needle to prevent variceal bleeding. Multiple variceal ligations were added to stop the variceal blood flow. Contrast-enhanced CT 3 days after EISML showed the thrombus formation in esophagogastric varices and the left gastric vein. The blood supply route-targeted EISML can be a feasible procedure for giant esophagogastric varices.
1例高危型巨大食管胃静脉曲张患者接受了以供血途径为靶点的内镜下注射硬化剂联合多点套扎术（EISML）治疗。在数字减影血管造影室全身麻醉下，于左下侧卧位插入内镜。旋转C形臂以获得透视的正位影像。在穿刺食管静脉曲张之前，将附着在内镜尖端的气囊充气以阻断曲张静脉血流。穿刺时，在透视下确认血管内注射，从食管胃静脉曲张至胃左静脉根部，每隔5分钟逆行注射总量为18 m的5%油酸乙醇胺与碘帕醇混合液，保持血流停滞25分钟。拔针后立即对注射的曲张部位进行套扎，以防止曲张静脉出血。增加多点曲张静脉套扎以阻断曲张静脉血流。EISML术后3天的增强CT显示食管胃静脉曲张及胃左静脉内血栓形成。以供血途径为靶点的EISML对于巨大食管胃静脉曲张可能是一种可行的治疗方法。
