Argon plasma coagulation (APC) has been widely used for various hemostatic procedures and the treatment of early cancer. In the present study, we used APC as preventive consolidation therapy of esophageal varices and studied its usefulness. Subjects were 13 patients with esophageal varices who had previously received EVL and/or EIS. Results were compared with those of 20 patients who didn't receive the APC treatment (non-APC group). APC was performed twice at an interval of one week with argon flow rate of 2 L/min and high-frequency output of 60 W. Complications were slight chest pain in five and transient low grade fever in nine. Varices were completely disappeared in all patients. Only one patient showed recurrence (F₁ RC (+)). The annual cumulative recurrence rate in the APC group was 12.5%, which was significantly lower than that of the non-APC group (61.0%, p=0.03). These results indicate that APC technique as preventive consolidation therapy of esophageal varices is useful, because it shows a preferable safety profile with few complications.

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To assess the long term prognosis of transjugular intrahepatic portosystemic shunt (TIPS), a total of 28 patients with portal hypertension who had been treated with TIPS were studied. Of these, 16 patients underwent TIPS for esophago-gastric varices, 10 for refractory ascites and two for portal hypertensive gastropathy. Six of these patients were complicated with hepatocellular carcinoma. Child-Pugh score of 26 patients who survived 1 year or longer after TIPS was 8.4 before TIPS, 8.0 at 4 weeks and 8.8 at 1 year. Score of ascites was significantly improved after TIPS. A shunt occlusion rate was as high as 60.7%. However, shunt obstruction was accessible for a second intervention. Overall patency was 96% at 1 year, 96% at 2 years and 87% at 3 years. One patient had rebleeding of varices after TIPS. Survival rates were 92% at 1 year, 40% at 3 years and 30% at 5 years. A mean survival period was 27 months. Overall, 15 patients died : 6 patients died of hepatic failure and 4 patients died of hepatocellular carcinoma. Because Child-Pugh score showed no significant change before and after the procedure, TIPS appears to be safe and effective for portal hypertension which is difficult to be controlled by other 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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