Recently, endoscopic variceal ligation therapy (EVL) has become a valuable alternative to endoscopic injection sclerotherapy (EIS) in the treatment of esophageal varices. However, EVL originally developed is known to suffer early recurrence and bleeding. We have treated 123 patients with esophageal varices with eradicative EVL (eEVL) which uses up to 20 O-rings and evaluated a long-term prognosis and analyzed risk factors for recurrence after eEVL. Cumulative rate of no variceal recurrence was 90.7% at 1 year and 63.6% at 5 years. The rate was higher in Child A than in Child B and C (p = 0.03), in varices with red color sign negative (p = 0.05), with cross-sectional area (CSA) at gastric cardia<100 mm² before EVL (p = 0.01) with CSA<10 mm² after eEVL (p = 0.004), and without remaining vessels at the lower esophagus after eEVL (p= 0.007), respectively. Multiple regression analysis revealed that the last factor is the most reliable predictor of recurrence (risk ratio =7.41, p =0.04). From these observations, it is suggested that in order to obtain a long term recurrence-free period submucosal vessel at the lower esophagus should be eradicated at the end of eEVL.

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We routinely perform mucosa-fibrosing therapy in addition to endoscopic variceal ligation (EVL) with or without sclerotherapy. We have compared the effect of mucosa-fibrosing therapy with argon plasma coagulation performed in 15 patients (APC group) with that with paravariceal injection of 1% polidocanol (AS) performed in 34 patients (AS group). Number of treatment sessions to eradicate varices in APC group (2.2±0.5 in total and 1.1 ±0.3 for mucosal fibrosing) was significantly smaller than that of AS group (2.8±0.5 and 1.6±0.6, respectively, p<0.05). One and 2 year cumulative recurrence-free rate of APC group (93.3% and 84%) were not different with those of AS group (87.9% and 76.9%), respectively. Stricture of esophagus was observed in 3 patients of AS group. Incidence of other complications was not different between both groups. It is suggested that mucosa-fibrosing therapy with APC is superior to that with AS because it causes more uniform ulcers, and is less invasive and more cost effective with the efficacy comparable to that with AS.

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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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[in Japanese]

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[in Japanese]

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