Endoscopy 2003; 35(11): 940-945
DOI: 10.1055/s-2003-43475
Original Article
© Georg Thieme Verlag Stuttgart · New York

Clinical Evaluation of Combined Endoscopic Variceal Ligation and Sclerotherapy of Gastric Varices in Liver Cirrhosis

Y.  Arakaki1 , K.  Murakami2 , K.  Takahashi2 , R.  Sato2 , T.  Okimoto2 , H.  Ishitobi2 , M.  Nasu2 , J.  Kagawa3 , M.  Kodama3 , T.  Fujioka3
  • 1Division of Gastroenterology, Almeida Memorial Hospital, Oita, Japan
  • 2Second Dept. of Internal Medicine, Oita Medical University, Oita, Japan
  • 3Dept. of General Medicine, Oita Medical University, Oita, Japan
Further Information

Publication History

Submitted 5 November 2002

Accepted after Revision 22 June 2003

Publication Date:
07 November 2003 (online)

Background and Study Aims: Endoscopic injection sclerotherapy (EIS) using cyanoacrylate and balloon-occluded retrograde transvenous obliteration (B-RTO) are the main procedures used to treat gastric varices. However, neither technique is free of problems. EIS for gastric varices may cause embolism in other organs; B-RTO requires a gastrorenal shunt and may aggravate esophageal varices. We have developed a combined form of endoscopic therapy involving band ligation and sclerotherapy which is an effective and safe procedure for treating gastric varices.
Patients and Methods: Fifty-six patients with gastric varices and liver cirrhosis were treated at Almeida Memorial Hospital from June 1997 to May 2002 using the combined procedure. Each gastric varix was tightly ligated with O-rings, and 1 % polidocanol was injected into the submucosa around the ligated varix. If necessary, additional sclerotherapy was carried out after the initial treatment.
Results: The rate of hemostasis for variceal bleeding was 100 %, and no critical complications were noted. Complete disappearance of the gastric varices was observed endoscopically in all cases. Computed tomography showed that collateral vessels outside the gastric wall were not occluded by the treatment. Endoscopic follow-up examinations were carried out, and gastric varices recurred in seven patients (12.5 %). Only two of the patients (3.6 %) had a small amount of oozing bleeding. Additional endoscopic variceal ligation (EVL) and/or EIS were performed in these seven cases, and none of the patients died as a result of a bleeding gastric varix.
Conclusions: The combined procedure was easily performed immediately after endoscopic examination, and required no special apparatus. It was found to be a safe and effective method of treating gastric varices.

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K. Murakami, M. D.

Second Dept. of Internal Medicine · Oita Medical University

1-1 Idaigaoka, Hasama · Oita 879-5593 · Japan

Fax: + 81-97-549-4245 ·

Email: murakam@oita-med.ac.jp