In endoscopic sclerotherapy for esophageal varices, perforating veins can interfere with hemostasis during treatment and cause difficulties in completing the procedure, leading to short-term recurrence. We devised a method for closing perforating veins identified by preoperative ultrasonic endoscopy with N-butyl-2-cyanoacrylate (NBCA) to enable conventional sclerotherapy. In total, there were 22 patients with a preoperatively identified perforating vein; 9 cases were closed with NBCA (Group A), and 13 cases were closed by other means (ethanol, endoscopic ligation, balloon tamponade) (Group B); these groups were compared The average dose of sclerosant was significantly lower in Group A (8.3 ml) compared to group B (12.2 ml, p=0.038). The consolidation rate after 3 months was also significantly lower in group A (22.2% in group A vs. 76.9% in group B, p=0.036). Group A also had shorter treatment times, less treatment frequency, and fewer hospital days than B group and showed better results in invasiveness and treatment content. Using NBCA for perforating vein closure enabled reliable hemostasis, safe completion of a series of sclerotherapy procedures, and improved curative possibility.

Esophagogastric varices is one of the most important clinical symptoms in patients with primary biliary cholangitis (PBC) in addition to jaundice and skin itching, since the varices are in general intractable, and frequently recur following endoscopic therapies. Thus, careful observation of varices should be done in patients with PBC. On the other hand, portal hypertensive gastropathy (PHG) may develop in patients manifesting portal hypertension, and these gastrointestinal disorders are seen even in patients with asymptomatic PBC (a-PBC). The significance of PHG, however, is not clarified in patients with a-PBC, and endoscopic examinations were done serially in patients with PBC. A total of 112 patients with a-PBC were enrolled. Among them, PHG was found in 21 patients (21.9%) at baseline, and developed in 6 patients (5.4%) following the enrollment. When clinical features were compared between 27 patients with PHG and the remaining 85 patients, the cumulative survival rates did not differ between both groups, while the periods until diagnosis as having symptomatic PBC were shorter in the former patients than in the latter patients, and a percentage of patients in whom esophagogastric varices developed during the observation periods were higher in the former patients than in the latter patients (74% vs 40%). Moreover, a multivariate analysis revealed that PHG was a significant factor responsible for progression to symptomatic PBC in patients with a-PBC. These results suggest that the frequency of patients with a-PBC who will be diagnosed as having portal hypertension-type symptomatic PBC in the future is higher in those with PHG than in those without PHG, and careful observations for portal hypertension-related events as well as jaundice and skin itching are require for such patients.