1993 Volume 43 Pages 87-91
A newly developed“Endoscopic variceal ligation (EVL) ”is a method which has been evaluated for its usefulness, safety and easyhandling for the treatment of esophageal varices. However, no study on its use in cardia varices has been reported.
We have recently evaluated the EVL (Stiegmann's method) and the results are reported before. A small elastic rubber band was used to occlude and eradicate the varices, with an adjunct therapy of endoscopic injection sclerotherapy (EIS) for cardia varices. Five patients with esophago-gastric varices (three male and two female) were treated with EVL for cardia varices. The timing of therapeutic indication for these cases was : urgent in two, elective in one and prophylactic in two cases.
All the cases had good clinical course without post EVL rebleeding. We have determined the following indications of EVL in the present study : 1. Aged patient having multiple complications or other organic diseases ; 2. Patients having allergic reaction to sclerosant ; 3. Patients with poor condition who requires urgent therapy ; 4. Patients with rebleeding from the ulcer after EIS ; and 5. Patients who achieved no downsizing cardia varices though injection of sclerosant was conducted blood supply route. EVL alone could not have completely eradicated of cardia varices because a large amount of blood flows towards the cardia varices, as a results of endoscopic varicealography during injection sclerotherapy (EVIS) performed after EVL.
We have concluded that EVL can achieve therapeutic efficacy by combination use of EIS as an adjunct therapy.
