1994 Volume 44 Pages 53-56
It is well known fact that treatment of giant straight esophageal varix is almost difficult. Therefore, feeders of the giant straight varix is examined by endoscopic varicealography during injection sclerotherapy (EVIS) . From December 1977 to September 1992, 32 cases of the straight varix were treated with EVIS.
Our technique is to embolize esophageal varices and their feeders by using oral side balloon attached to the tip of the endoscope that was inflated to stop the blood flow of the varices during treatment and intravariceally injecting 5% EO with iopamidol or meglumine amidotrizoate.
It was reported that their feeders were classifed with left gastric vein (LGV) , short gastric vein (SGV) , fundic plexus (FP, LGV communicated with SGV) and unknown by EVIS. Also, it was reported that major shunts except esophageal varices were done with abdominal type (between systemic circulation and part of the feeders) and thoracic type (between systemic circulation and parts of esophageal varix) .
Results : In 31 cases, feeders were LGV and 7 of them had shunt of thoracic type. Remaining one case had unknown feeders and two shunts of thoracic type. None had SGV, FP and shunts of abdominal type. In the cases of shunt of thoracic type, recurrence rates were greater and numbers of injection during sclerotherapy to eradicate the varices were larger than in the cases without shunt of thoracic type.
As a result, the giant straight esophageal varix had direct effect of pressure from portal vein. It was thought to be especially difficult to treat the straight varices with shunt of thoracic type. However, all straight esophageal varices were thrombosed by sclerotherapy with the sclerosant-contrast medium mixture and the oral side balloon (EVIS technique) .
