We have studied the usefulness of MR angiography (MRA) to evaluate the effect of treatment for esophageal varices due to liver cirrhosis. Before and after each session of variceal therapy, breath hold three-dimensional Gadolinium-enhanced MRA was performed in 17 patients with esophageal varices. Endoscopic injection sclerotherapy (EIS), either intra-variceal injection or mucosa-fibrosing method (para-variceal injection, heater probe method or argon plasma coagulation) was performed in all patients. MRA revealed esophageal varices in the lower portion of esophagus and either of left gastric vein or posterior gastric vein in all patients. In 7 patients who underwent varicealography, and showed positive result, MRA also showed a high degree of improvement. However, there was no relationship between the degree of improvement and a recurrence rate 6 months after the treatments. On the other hand, a recurrence rate of a group of patients in whom EIS caused ulcer was lower than that in whom EIS caused less severe ulcer or no ulcer. In conclusion, MRA was safe and useful to evaluate effect of EIS. Furthermore, EIS with mucosa-fibrosing method is effective for long term non-recurrence.

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We have evaluated indication of surgical treatment for esophago-gastric varices based on our experience of 5 patients with the varices. Causes of varices were liver cirrhosis in 3 and idiopathic portal hypertension in 2. Four patients had previously undergone endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL), but failed to respond to these treatments. Four patients received operations prophylactically, while remaining one underwent an emergency operation for rebleeding with shock during angiography for balloon-occluded retrograde transvenous obliteration (B-RTO). The patient operated tended to have following characteristics; (1) resistance to EIS, or rapid growth, (2) splenomegaly and complicated roots of collateral vessels, (3) difficulty in performing B-RTO. Two patients underwent esophageal transection, and 3 were treated with Hassab's operation, respectively. All patients showed a favorable recovery, and recurrence was not observed by endoscopic examinations during follow-up. Some cases even showed an improvement of hypersplenism and liver functions. We propose that surgical treatments should be taken in consideration for cases who are resistant to conservative endoscopic treatments.

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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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