内镜超声检查评价胃底静脉曲张栓塞术

目的 探讨小探头超声检查评价胃底静脉曲张栓塞术的临床价值。方法 将肝硬化伴有内镜确诊及可疑胃底静脉曲张患者分为两组，超声组109例（其中急性活动性出血患者67例）中内镜确诊78例，31例可疑胃底静脉曲张小探头超声检查确诊21例，对该组99例确诊患者行组织黏合剂（Histoacryl）栓塞治疗，术后即行超声检查，发现栓塞不完全者再次予以治疗；对照组76例（其中急性活动性出血患者62例），均为内镜诊断明确者，行组织黏合剂栓塞治疗。3个月后两组均采用小探头超声复查，以超声所见评价疗效。结果 两组急诊止血率均为100％；超声组3周内无再出血患者，对照组早期再出血率为11．8％（9／76），两组之间差异有非常显著意义（P〈0．01）；术后3个月小探头超声随访，超声组中胃底静脉曲张消失率为97．0％（96／99），对照组为76．3％（58／76）。两组之间差异亦有非常显著意义（P〈0．01）。结论 小探头超声检查评价胃底静脉曲栓塞术具有较高的价值。     

小探头超声指导下的胃底静脉曲张栓塞术

为探讨小探头超声检查在诊断胃底静脉曲张及指导胃底静脉曲张栓塞术中的价值，并评价组织黏合剂的临床疗效，我们对42例肝硬化患者行内镜、小探头超声检查，对诊断为胃底静脉曲张者行内镜下组织黏合剂栓塞治疗，1周后再次小探头超声检查．疗效较满意．现报道如下。     

内镜下组织粘合剂注射联合套扎治疗食管胃底静脉曲张破裂出血的疗效观察

目的评价急诊内镜下组织粘合剂（α-氰丙烯酸烷基脂）注射联合套扎治疗食管胃底静脉曲张破裂出血的临床疗效。方法2008年1月至2009年1月间21例食管胃底静脉曲张破裂出血患者接受急诊内镜下胃底曲张静脉组织粘合剂注射联合食管曲张静脉套扎（EVL）治疗,对其治疗疗效进行回顾性分析。结果21例患者的急诊止血有效率达95％（20／21）,未出现严重并发症。结论急诊内镜下组织粘合剂注射联合套扎治疗食管胃底静脉曲张破裂出血,止血疗效确切,并发症发生率低,值得推广。     

组织粘合剂注射联合门静脉栓塞治疗食管胃底静脉曲张出血的临床研究

目的评价内镜下注射组织粘合剂联合经皮经肝胃冠状静脉栓塞治疗食管胃底静脉曲张的疗效。方法将57例食管胃静脉曲张患者分为2组，分别进行内镜下组织粘合剂注射（单纯组，38例）和内镜下组织粘合剂注射联合经皮经肝胃冠状静脉栓塞（联合组，19例）治疗。比较2组疗效。结果联合组近期再发出血1例，6个月后再发出血2例，分别占5．3％和10．5％；术后3～6个月行食管钡餐检查，食管静脉曲张消失或基本消失13例（68．4％），明显好转6例。单纯组近期再出血7例，6个月后再发出血12例，分别占18．4％、31．6％；术后3～6个月行食管钡餐检查，食管静脉曲张消失或基本消失16例（42．1％），明显好转22例。结论相对于单纯内镜下组织粘合剂注射治疗，联合经皮经肝胃冠状静脉栓塞术是一种安全有效的治疗食管胃底静脉曲张的方法。     

超声内镜对食管胃底静脉曲张的诊断及治疗疗效判断

急性消化道出血是消化系疾病中常见的临床症状,其中肝硬变失代偿导致的食管或胃底静脉曲张(esophageal varices,EV/gastric varices,GV)破裂出血尤为棘手,严重时常危及生命,因此,准确的诊断和对治疗疗效的判断至关重要.近年来,国内外应用硬化剂、组织粘合剂(如histoacryl)、皮圈套扎等在紧急内镜止血及预防治疗上取得了显著疗效,但对于上述各治疗方法的疗效评价仍缺乏客观的依据及相对量化的标准且有时仅依赖常规内镜下的肉眼判断,尤其是对胃底曲张静脉的诊断还不够准确.我们复习近期文献同时结合作者自己的临床实践体验,对超声内镜(endoscopic ultrasonography,EUS)在食管和胃底曲张静脉诊断及治疗疗效判断中的临床应用作一概述.     

经内镜栓塞术联合套扎术治疗食管胃底静脉曲张出血的疗效观察

目的探讨胃底静脉曲张栓塞术联合内镜下食管静脉曲张套扎术（EVL）治疗肝硬化上消化道出血的疗效。方法经急诊胃镜检查发现活动性胃底静脉曲张出血合并Ⅱ°以上食管静脉曲张且排除其他病因的上消化道出血患者共156例,分为治疗组和对照组,治疗组胃底静脉曲张组织粘合剂栓塞同时食管静脉EVL治疗;对照组胃底静脉曲张组织粘合剂栓塞治疗2个月后行食管静脉EVL。结果两组均未发生与治疗相关的并发症。止血成功率治疗组为96．3％（77／80）,对照组为97．4％（74／76）,（P〉0．05）;近期再出血率治疗组为6．4％（5／78）,对照组为21．3％（16／75）,两组差异有统计学意义（P〈0．05）;两组患者随访6个月,再出血率分别为13．0％（9／69）、25．4％（17／67）,差异有统计学性意义（P〈0．05）。胃底静脉曲张改善总有效率治疗组和对照组分别为61．6％、59．1％,食管曲张静脉改善总有效率为74．0％、67．9％,差异均无统计学意义。结论胃底静脉曲张栓塞联合EVL是治疗肝硬化胃底静脉曲张出血并食管静脉曲张的安全有效方法,同时联合治疗更能降低再出血率。     

CT门脉成像联合内镜超声指导肝硬化食管胃底静脉曲张精准治疗的随机对照研究

目的 探讨CT门脉成像联合内镜超声指导下肝硬化食管胃底静脉曲张精准治疗的疗效及安全性。 方法 选择2013年1月至2015年1月间因肝硬化合并食管胃底静脉曲张破裂出血并行内镜下治疗的住院患者共130例,采用前瞻性随机对照试验方法,用数字表法将患者随机分为试验组及对照组各65例。试验组患者用CT门脉成像评估食管胃底曲张静脉的数量和静脉曲张的程度,再行内镜下治疗;第二次治疗前行超声内镜检查评估食管旁及穿支静脉情况,再治疗。对照组直接进镜观察食管胃底静脉曲张范围及程度,根据经验行内镜下治疗。 结果 试验组最终完成治疗及随访的患者共62例,对照组63例。平均治疗次数试验组明显少于对照组（3.00±0.76比5.63±0.92,P=0.000）, 静脉曲张消失时间试验组明显短于对照组［（7.25±1.16）个月比（8.88±1.64）个月,P=0.039］。静脉曲张复发率试验组明显低于对照组［1.6％（1／62）比12.7％ （8／63）,P=0.040］。胸腔积液发生率试验组明显低于对照组［0（0／62）比9.5％（6／63）,P=0.040］。总体并发症发生率试验组明显低于对照组［27.4％（17／62）比58.7％ （37／63）,P=0.003］。 结论 CT门静脉成像联合内镜超声指导治疗肝硬化食管胃底静脉曲张安全有效。     

内镜套扎及组织胶栓塞治疗食管胃底静脉曲张出血的疗效观察

【摘要】目的探讨内镜下静脉曲张套扎术（EVL）及组织胶栓塞术治疗食管胃底静脉曲张出血的临床疗效。方法回顾性分析452例食管胃底静脉曲张出血患者的食管静脉曲张EVL和胃底静脉曲张组织胶栓塞术治疗及随访情况,对治疗效果及并发症进行总结。结果急诊止血成功率为100．0％（145／145）,早期再出血率为1．8％（8／452）,早期不良反应发生率为50．0％（226／452）,并发症发生率为12．4％（56／452）。EVL治疗食管静脉曲张有效率和显效率分别为32．5％（145／446）和40．4％（180／446）;组织胶栓塞术治疗胃底静脉曲张有效率和显效率分别为32．5％（136／419）和27．4％（115／419）。426例随访9—37个月,平均18个月,再出血发生率为10．1％（43／426）,6个月生存率为97．9％（417／426）,1年生存率为89．9％（383／426）。结论EVL及组织胶栓塞术治疗食管胃底静脉曲张疗效较好,两者联合治疗操作简单、疗效好、患者创伤小,既可以用于急诊止血,也可用于二级预防。     

消化内镜诊治的历程与展望

消化内镜自1963年引入中国，至今已30余年，其用途也已由单纯诊断进入到诊断与治疗相结合的阶段，包括息肉摘除、食管静脉曲张的硬化剂或套扎治疗、胃底静脉曲张的组织粘合剂治疗、逆行胰脏管造影（ERCP）及Oddi括约肌切开取石、胆总管狭窄的鼻胆外引流或内置管引流、消化道出血的药物注射、电凝、激光或微波止血和食管良、恶性狭窄的内置管、气囊扩张、激光或微波治疗等[1]。随着内镜器械的不断改进与创新，近20年开发了超声内镜（EU）、超声小探头和超声内镜下穿刺等，其诊断水平不断提高，临床应用范围也日益扩大。慢性胰腺炎、门静脉…     

小探头超声（MPS）检查在消化道疾病临床应用的初步探讨

目的传统内镜尚难对消化道粘膜隆起病灶的性质以及肿瘤浸润深度作出判断。本文旨在评估小探头超声（ＭＰＳ）检查在此方面的应用价值。方法对６０例（手术患者３９例）常规内镜检查发现病灶的患者，于内镜检查的同时行ＭＰＳ检查，其结果与常规内镜下的肉眼诊断、病理活检以及手术后病理结果作对比。结果对粘膜隆起病灶且内镜下病理活检阴性的患者，与手术发现比较。ＭＰＳ的诊断准确率为９０．５％（１９／２１）；而对于消化道肿瘤的浸润深度，ＭＰＳ的判断均与手术后结果相符１００％（２３／２３）。结论对消化道粘膜隆起病灶的性质鉴别，ＭＰＳ显著优于常规内镜及病理活检，具有一定临床诊断价值；对消化道肿瘤，ＭＰＳ仅对肿瘤浸润消化道壁的深度能作出准确判断，而对周围淋巴结累及与邻近脏器转移的诊断仍有其局限性。     

Preliminary assessment of miniprobe sonography in the diagnosis of gastric varices and evaluation of treatment with Histoacryl

OBJECTIVE : In comparison with conventional endoscopy, the clinical value of miniprobe sonography (MPS) was assessed both in the diagnosis of gastric varices (GV) and in the evaluation of its treatment with the tissue adhesive agent Histoacryl. METHODS : Twelve patients with liver cirrhosis and portal hypertension caused by hepatitis B in nine cases and hepatitis C in three cases were examined by MPS to verify the presence of gastric fundic varices before and after endoscopic treatment with Histoacryl. Curative efficacy of Histoacryl treatment was defined by the finding of variceal lumen obliteration characteristics in the ultrasonic image. RESULTS : Gastric fundic varices were detected in 10 patients by using MPS, however, only seven cases were detected by using conventional macroscopic examination. For gastric fundic varices, the diagnostic accuracies of standard endoscopy and MPS were 75% (9/12) and 100% (12/12), respectively. Furthermore, MPS was able to produce a practical ultrasonic image of complete or incomplete variceal vessel lumen obliteration for use in the assessment of the efficacy of endoscopic treatment with Histoacryl. CONCLUSIONS : Miniprobe sonography was found to be significantly superior to conventional macroscopic diagnosis in both the detection of fundic varices and the evaluation of the efficacy of endoscopic therapy. Moreover, MPS could play an important role in follow up and in evaluation of the need for further treatment. Therefore, MPS appears to be a safe and very useful clinical technique in evaluating patients with portal hypertension with respect to the detection of fundic varices and may help in selecting patients for appropriate therapy.     

Clinical and endoscopic features of gastric varices secondary to splenic vein occlusion

Aim: This study provides a retrospective evaluation of cases with gastric varices secondary to splenic vein occlusion. Methods: Our study group consisted of 14 patients. The clinical manifestations, diagnostic methods and therapeutic modalities were analyzed retrospectively. Results: Eleven patients had co‐existing pancreatic diseases: seven with chronic pancreatitis, three with cancer of the pancreatic body or tail and one with severe acute pancreatitis. Among the three remaining patients, one had advanced left renal cancer, one had myeloproliferative disease and the third had splenic vein occlusion due to an obscure cause. A diagnosis of gastric varices was made following endoscope gastroduodenoscopy or endoscopic color Doppler ultrasonography (ECDUS), and splenic vein occlusions were diagnosed from enhanced computed tomography in all cases. Specific findings of gastric varices secondary to splenic vein occlusion were based on ECDUS color flow images of gastric variceal flow that clearly depicted round cardiac and fundal regions at the center, with varices expanding to the curvatura ventriculi major of the gastric body. For three cases with gastric variceal bleeding, endoscopic injection sclerotherapy using a mixture of histoacryl and lipiodol (70% histoacryl solution) was performed, after which no further bleeding from gastric varices was detected. Due to a high risk of gastric variceal rupture, splenectomy was performed in two cases and splenic arterial embolization in another two cases. Conclusion: ECDUS color flow images of gastric variceal flow depicted specific findings of gastric varices secondary to splenic vein occlusion. Treatment should take into account the diseases underlying these conditions.     

An open pilot study of the effects of a human fibrin glue for endoscopic treatment of patients with acute bleeding from gastric varices

BACKGROUND: Optimal treatment for gastric variceal bleeding remains to be determined. The use of conventional sclerosing agents is associated with high rates of recurrent bleeding. Other agents, such as cyanoacrylate, have significant complication rates and can damage endoscopic equipment. The risk of prior-associated disease has caused concern regarding the use of bovine thrombin. METHODS: Beriplast-P (human thrombin) forms a fibrin clot at the needle tip immediately upon injection through a double lumen needle. In 10 patients with gastric variceal bleeding, a median dose of 6 mL of Beriplast-P was injected into gastric varices. OBSERVATIONS: Immediate hemostasis was achieved in 7 of 10 patients (70%) with a single injection. At a median follow-up of 8 months, there was no recorded episode of recurrent bleeding from gastric varices. CONCLUSIONS: These results suggest that Beriplast-P is useful in the treatment of gastric variceal bleeding. Refinements in the design of the injection needle may improve the efficacy of this novel therapy.     

UNUSUAL FOREIGN BODY: ESOPHAGEAL IMPACTION AFTER CYANOACRYLATE INJECTION FOR GASTRIC VARICES

Cyanoacrylate injection has been found in large series to be a remarkably safe and efficient treatment of gastric variceal bleeding. Dysphagia is a common local side‐effect of endoscopic intravariceal histoacryl injection. A 49‐year‐old woman with diagnosis of cirrhosis and portal hypertension related to hepatitis B virus infection was admitted to the Ibni Sina hospital due to dysphagia that started after injection of N‐butyl‐2‐cyanoacrylate (histoacryl) for gastric varices. She had undergone endoscopic gastric intravariceal histoacryl injection 2 years previously and again 1 month before the admission. There were no complications related to injection of the histoacryl or the endoscopy procedure itself. Dysphagia started immediately after the second endoscopy and was refractory to prokinetic and analgesic medication. She did not have any other complaint of medical significance. A diagnostic endoscopy revealed a heterogeneous foreign body stuck in the distal esophagus. Dysphagia resolved after endoscopic removal of the foreign body by endoscopic biopsy forceps. The heterogeneous material, which was mixed with food particles and tissue debris, was analyzed via infrared spectrophotometer and was found to be cyanoacrylate glue. In the present case, extrusion of the glue occurred earlier then expected and retching or vomiting might have dislodged the extruded glue from the stomach to the esophagus. If prolonged and intractable dysphagia starts after the endoscopy procedure, impaction of glue to the esophagus should be considered.     

Portale Hypertension

Bleeding of gastro-oesophageal varices is one of the most serious complications of portal hypertension. An early endoscopic examination of patients with cirrhosis has become standard practice because direct measurement of portal pressure is not universally available. If varices are present prophylaxis to prevent bleeding can be achieved by non-selective betablocker therapy. In the face of contraindications or intolerance to this therapy, endoscopic band ligation is an alternative prevention strategy for high-risk patients. Acute variceal haemorrhaging can be controlled in about 90% of the cases by endoscopic sclerotherapy or band ligation. In addition, vasoactive drugs like octreotide or terlipressin can be used to reduce portal pressure and to control haemorrhaging. Prevention of recurrent bleeding can be achieved through a consistent band ligation. The most promising therapy for gastric variceal bleeding is the injection of histoacryl. In cases of endoscopic treatment failure, a balloon tamponade or a portosystemic shunt are rescue treatment options.     

金属夹联合组织胶注射治疗胃静脉曲张伴自发性门体分流的临床研究（含视频）

目的探讨金属夹联合组织胶注射治疗胃静脉曲张伴自发性门体分流的疗效和安全性。方法2016年5月至2018年10月,于首都医科大学附属北京地坛医院行金属夹联合组织胶注射治疗的合并自发性门体分流的32例胃静脉曲张出血患者纳入回顾性分析,总结治疗情况及并发症情况。结果32例患者均成功止血,组织胶中位使用量为3.8 mL。静脉曲张根除或基本消失9例,静脉曲张改善23例。术后72 h、7 d、14 d及6周均无再出血,无异位栓塞发生。结论金属夹联合组织胶注射治疗胃静脉曲张伴自发性门体分流有良好的安全性和短期疗效。     

Caroli病合并食管胃底静脉曲张内镜下治疗5例临床分析并文献复习

Caroli病合并食管胃底静脉曲张(gastreoesophageal varices,EGV)患者5例均行内镜下治疗,其中套扎治疗1例,余4例食管行硬化剂注射治疗,胃底行组织胶注射治疗。5例患者均完成了治疗后3个月和1年的随访,无再发出血。Caroli病合并EGV行内镜下治疗是有效的治疗方式,具有创伤小,效果好,操作简捷等优点,临床上应强调治疗后感染的预防。     

内镜组织黏合剂注射联合套扎序贯治疗食管胃静脉曲张疗效观察

背景：临床上对胃静脉随张（GV）合并食管静脉曲张（EV）的内镜治疗方法和治疗时机选择尚未统一。目的：探讨内镜组织黏合剂注射联合套扎序贯治疗食管胃静脉曲张的疗效及其最佳时机。方法：2007年1月。2009年6月南京医科大学第一附属医院56例内镜检查确诊为GV活动性出血合并中重度EV者纳人研究,其中26例于GV组织黏合剂注射1周后行EV套扎（A组）,30例注射后立即行EV套扎（B组）。回顾性分析两组患者的止血率、治疗相关并发症发生情况、治疗后1个月内和6个月内再出血率以及食管胃静脉曲张改善有效率。结果：A组与B组问止血率（96．2％对96．7％）和食管胃静脉曲张改善总有效率（GV：72．7％对72．0％;EV：81．8％对84．0％）无明显差异,A组治疗后1个月内和6个月内再出血率均显著高于B组（1个月内：26．1％对10．3％,P〈0．05;6个月内：45．5％对32．O％,P〈0．05）。两组均无明显治疗相关并发症发生。结论：内镜GV组织黏合剂注射后立即行EV套扎序贯治疗食管胃静脉曲张安全、有效．值得在临床上推广应用。     

Endoscopic ablation with cyanoacrylate glue for isolated gastric variceal bleeding

BACKGROUND: Endoscopic ablation with cyanoacrylate glue may achieve gastric variceal obliteration. A prospective evaluation of its therapeutic effects on bleeding gastric varices was conducted, focusing on endoscopic features. METHODS: Thirty-seven patients with bleeding gastric varices underwent endoscopic ablation with cyanoacrylate. RESULTS: Patients with localized-type gastric varices (n = 14) had a better clinical course in terms of recurrent bleeding, variceal eradication, and survival than those with diffuse-type gastric varices (n = 23) after endoscopic ablation with cyanoacrylate. These clinical effects were related to the vascular anatomy of the gastric varices as determined by varicography and 3-dimensional CT. Type 1 vascular anatomy (one varicose vessel without noticeable ramifications) was much more common (86%) in localized-type gastric varices, whereas type 2 vascular anatomy (multiple varicose vessels with complex connecting ramifications) was found almost exclusively (91%) in diffuse-type gastric varices. CONCLUSIONS: Endoscopic ablation with cyanoacrylate is an effective and safe procedure for patients with bleeding gastric varices. Determination of variceal anatomy may be useful for improving treatment strategies for such patients.     

New techniques: combined endoscopic injection sclerotherapy and ligation for acute bleeding from gastric varices

BACKGROUND/AIMS: Combined endoscopic injection sclerotherapy and endoscopic variceal ligation was used for the treatment of acute bleeding from gastric varices. METHODOLOGY: Between July 1995 and August 1998, three cirrhotic patients with acute bleeding from gastric varices were treated. Endoscopic variceal ligation of the puncture point and bleeding point was performed simultaneously. RESULTS: Acute bleeding from the gastric varices was successfully stopped in all cases. CONCLUSIONS: Combined endoscopic injection sclerotherapy and endoscopic variceal ligation can be used to stop bleeding and prevent rebleeding from gastric varices.