Low power diode laser treatment using indocyanine green for eradication of esophageal varices.
OBJECTIVE
Endoscopic variceal ligation (EVL) is an alternative to sclerotherapy for the treatment of esophageal varices, but is associated with higher rates of recurrence and subsequent bleeding than sclerotherapy. To prevent recurrence of varices after EVL, we have developed a low-dose diode laser therapy combined with the injection of indocyanine green, which allows enhanced tissue absorption of the laser beam selectively around varices. In this study we investigated the efficacy and safety of this technique.


METHODS
Eight patients with F2 or F3 esophageal varices were enrolled. At 1 week after EVL, indocyanine green solution (1 mg/ml) was injected submucosally around the remaining varices. A diode laser (power 10 watts) was applied to the surface from the esophagogastric junction to 5 cm above it. The spot size was kept to 5 mm in diameter.


RESULTS
Laser irradiation was performed safely, without bleeding from the varices, or perforation. There were no major complications. Endoscopy 1 month later showed F0 forms in seven patients, F1 in one patient, and no red color sign in any patient. No recurrence of varices has been observed in any of the patients during the follow-up period of at least 12 months.


CONCLUSIONS
This technique may provide a simple, safe and effective procedure, as an additional treatment to EVL, for the prevention of recurrence of esophageal varices.
Hino
S
S
Dept. of Endoscopy, Jikei University School of Medicine, Tokyo Japan. shoryok@attglobal.net
Kakutani
H
H
Ikeda
K
K
Yasue
H
H
Sumiyama
K
K
Uchiyama
Y
Y
Kuramochi
A
A
Matsuda
K
K
Arakawa
H
H
Kawamura
M
M
Masuda
K
K
Suzuki
H
H
Hayashi
T
T
Nakamura
N
N
Arai
T
T
Kikuchi
M
M
D000328:Adult; D004396:Coloring Agents / Q000008:administration & dosage*; D004932:Esophageal and Gastric Varices / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage*; D028022:Low-Level Light Therapy; D008297:Male; D008875:Middle Aged
D004396:Coloring Agents; D007208:Indocyanine Green