Abstract
Endoscopic injection sclerotherapy has been spreaded for the treatment of esophageal varices. Recently, endoscopic variceal ligation (EVL) has become popular as the easy technique. Clipping was also developed, and recognized the usefulness for hemostasis and marking. EVL and clipping are the new effective treatments for esophageal varices. We discussed the combination therapy of ligation and intra-variceal injection sclerotherapy for the improvement of therapeutic effect and the prevention of recurrence. We performed the combination therapy of clipping and intra-variceal injection sclerotherapy with 5 %ethanolamine oleate iopamidol (5%EO) for the treatment of esophageal varices (Clipping+5%EO therapy). We tried to perform for 18 patients, and achieved the improvement in all patients by clipping with the mean number of 3.3±1.4 sessions and sclerotherapy with the mean injected volume of 21.4±14.6 ml 5%EO in the primary therapeutic effect. We achieved the remission in 13 (72.2%) and the eradication in 7 (38.9%) out of 18 patients 15.5 months after the treatment. We could decrease the therapeutic sessions and the volume of sclerosant, and improve the therapeutic effect by Clipping+5%EO therapy compared with independent sclerotherapy. Clipping is the useful ligation for stopping the variceal blood flow by the clipping apparatus. The form of varices is not changed by clipping. We can keep the good endoscopic view field, and inject the sclerosant into the varices effectively. Clipping is the suitable method for the combination of intra-variceal injection sclerotherapy. We can also demonstrate endoscopic varicealography during injection sclerotherapy, and the incurable varices can be treated by Clipping+5%EO therapy. In conclusion, Clipping+5%EO therapy is the useful combination method for the therapy of esophageal varices.
