The purpose of this study is to clarify pathological, endoscopic and endoscopic-sonographic changes of esophageal wall after argon plasma coagulation (APC) therapy for esophageal varices. Our series included 21 patients with esophageal varices, who underwent APC as the consolidation therapy for esophageal varices. After the treatment, each patient underwent an endoscopic and endoscopic-sonographic follow-up. Pathological study was performed obtained in one patient. Endoscopic-sonographic study revealed a significant thickening of the submucosal layer of the esophagus, which persisted for more than one year. Pathological study proved marked infiltration of inflammatory cells and fibrosis both in the mucosal and the submucosal layer. The proper muscular layer was also in part involved. The cumulative 2-year recurrence rate was 13.8%. The collateral veins outside the esophageal wall did not show significant changes after APC. APC can achieve semi-permanent fibrosis involving both mucosal and submucosal layer. The extraluminal routes of the blood supply to the varices was however, not altered after APC. Thus, it is suggested that APC is effective as the consolidation therapy for esophageal varices.

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The efficacy of endoscopic therapy for risky esophageal varices associated with hepatocellular carcinoma (HCC) was evaluated. Total of 43 HCC patients with esophageal varices and of 21 patients without esophageal varices were enrolled in this study. Although endoscopic injection sclerotherapy (EIS) was performed for the majority of the cases, esophageal variceal ligation (EVL) was operated on a part of patients who had severe liver dysfunction or portal vein thrombosis grading greater than Vp3. The clinical factors which potentially influenced the prognosis after endoscopic therapy were examined by multivariate analysis. There was no significant difference in the survival period between HCC patients with esophageal varices and those without esophageal varices. It was revealed that the Child-Pugh classification and HCC stage significantly influenced prognosis. It is suggested that suitable endoscopic therapy for the esophageal varices should improve the prognosis of HCC patients with esophageal varices. However, in case of severe liver dysfunction and advanced HCC, indication of the treatment may not influence prognosis.

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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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