We investigated the mechanisms for the development of portal hypertensive gastropathy (PHG) in patients with portal hypertension and liver cirrhosis on the basis of pathologic findings, tissue blood flow and amount of hexosamine in the gastric mucosa. We found histologic changes including congestion, vasodilatation in both arterioles and venules and interstitial edema, decreased tissue blood flow and decreased concentration of hexosamine in mucosal layer of upper part of the stomach. These changes were closely related to microcirculatory disturbance, and were correlated with the existence and the degree of PHG. Therefore, we speculate that not only secondary congestion (passive congestion) of gastric wall caused by portal hypertension and mucosal ischemia but primary congestion (active congestion) due to a hyperdynamic circulatory state in the submucosal layer may play important roles in the development of PHG. Furthermore, the decreased production of mucopolysaccharides which may disrupt the protective mechanisms of gastric mucosa may also be involved in the pathogenesis of PHG.

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In Japan, endoscopic injection sclerotheraphy (EIS) is used as a complete techneque to eliminate esophageal varices, as is indicated by a low recurrence rate after treatment. While, very frequent and rapid recurrence is common following even if EIS is added after EVL treatment. We have reported that EVL is an easy and effective techneque with a low recurrence rate when applied to cases in whom the degree of RC-sign is semiquantatively lower than +. While a prognosis is very poor when EVL for cases with more severer varice. In this report, we have examined appropriate indications of EVL based on the pictures of endoscopic ultrasonography (EUS) using 20 MHz, miniature probe. Forty cases with esophageal varices were examined and devided to two groups by EUS findings according to our grading system. Twenty eight cases whose vessels surrounding esophagus were graded as more than moderate (Group A) were treated by EIS alone. While, 12 cases with slightly developed vessels (Group B) were treated by EVL followed by the injection of 5% ethanolamine oleate into residual mucosa of the lower esophagus. Cummurative non-recurrence rate after the therapy were compared by the Kaplan Meier's method between two groups. There were no differences in cummurative non-recurrence rates (3 years) between these two groups (Group A : 94.9%, Group B : 100%). These result suggest that EVL is effective when applied to varices whose esophageal vessels around the esophagus were slightly developed.

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[in Japanese]

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[in Japanese]

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Ascites resistant to medical therapy constitutes a serious complication in cirrhotic patients, and it has a poor quality of life. The insertion of a peritoneovenous shunt is available to refractory ascites, although long-term efficacy is unestablished. Denver peritoneovenous shunt was placed in 8 patients, who were all cirrhotics with hepatocellular carcinoma. The patients included seven males and 1 female and had a median age of 63.4 years. All had previously been treated with vigorous diuretic therapy and repeated paracentesis. Denver shunt was placed between the peritoneal cavity and the subclavian vein. In all patients, abdominal distention disappeared, ascites became controllable, and renal function was improved. Seven patients died; a median survival period was 4.1 months. We believe that refractory ascites in end-stage cirrhotic patients can be successfully treated by the placement of Denver shunt, which often results in relief of the ascites and improvement of quality of life.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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