[Etiology and management of esophageal varices].
The most common etiogenic disease of portal hypertension that we experience is liver cirrhosis, which accounts for 84% of all cases. In patients with portal hypertension, congestion by portal blood due to cirrhosis causes a rise in portal pressure and development of collateral circulation between the portal system and the postcaval system is observed. Esophageal varices are associated with higher mortality than any other symptom of portal hypertension and are an important consideration in treatment. When emergency endoscopic examination and diagnosis show esophageal variceal bleeding, the varices must be constricted directly using a Sengstaken-Brakemor tube. If hemostasis is maintained, medical and surgical procedures can be performed after the recovery of body strength. Endoscopic Injection Sclerotherapy (EIS) has recently been widely carried out to prevent variceal bleeding and its application is increasing. However, treatment with EIS alone is not sufficient in terms of long-term efficacy, and surgical treatment is effective, especially in patients with gastric varices or splenomegaly. For Child A and B groups, both with good liver function, non-shunting operation, especially, the SUGIURA procedure, shows a marked effectiveness on varices. For group Child C, EIS is selected. The newly-developed Transjuglar Intrahepatic Portasystemic Shunt (TIPS), is being used, recently. For hepatic insufficiency, liver transplantation is expected to be one of the method for future treatment. Cirrhosis is also commonly accompanied by hepatoma, and this must be taken into consideration in treatment.
Oura
S
S
2nd Department of Surgery, Faculty of Medicine, Juntendo University.
Kojima
K
K
Fukasawa
M
M
Beppu
T
T
Futagawa
S
S
D002404:Catheterization; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications*; D015911:Sclerotherapy