消化内镜下治疗胃静脉曲张的研究进展

胃静脉曲张(GV)患者容易出血,并且病死率高.目前GV的治疗方法尚未统一.内镜下注射组织胶治疗GV应用最为广泛,但其与各种并发症有关,包括异位栓塞和复发性出血.近年来,超声内镜(EUS)引导下治疗GV已经成为一种有前景的新方法,具有较高的技术及临床成功率和低复发率,值得临床推广.该文对GV的病因、分型和治疗选择,尤其是...     

食管胃底静脉曲张的内镜治疗

食管胃底静脉曲张破裂出血是门脉高压最严重的并发症之一，其病情凶险，首次出血的死亡率达40％～70％，再出血的发生率为60％～80％。内镜检查不仅可明确食管和(或)胃底静脉曲张破裂出血的诊断，而且还可在内镜直视下行止血治疗。现已证实内镜下注射硬化剂、组织粘合剂或皮圈套扎是治疗静脉曲张破裂出血的有效方法。     

内镜下治疗食管胃底静脉曲张八例

内镜下治疗食管胃底静脉曲张八例文黎明赵世泉刘红专近来内镜下治疗食管静脉曲张（ＥＶ）报道较多，但同时进行胃底静脉曲张（ＶＦＳ）治疗尚少见报道，作者对８例食管胃底静脉曲张进行了联合治疗，现报告如下。１．对象和方法：本组男６例，女２例，年龄３３～６５岁，病...     

无痛胃镜下治疗胃底静脉曲张疗效初探

近年来，内镜下治疗食管静脉曲张已得到广泛开展，取得了满意的临床效果，但对胃底静脉曲张(GV)的诊治，研究报道尚少。作者自2001年11月到2003年5月，在无痛胃镜下治疗胃底静脉曲张13例，取得了满意效果。     

超声内镜治疗胃底静脉曲张北大核心CSCD

胃底静脉曲张(GVs)破裂出血严重、复发率和死亡率高,随着超声内镜(EUS)技术的快速发展,通过EUS引导细针穿刺栓塞治疗GVs的新方法不断涌现,特别是EUS引导下弹簧圈置入联合组织胶(或明胶海绵、凝血酶)注射治疗GVs前景广阔,能显著提高临床疗效和安全性。文章对EUS治疗GVs的新技术进行全面综述,重点介绍这些技术的优点、可行性、安全性和局限性。     

胃底静脉曲张出血的内镜治疗

胃底静脉曲张（Gastric Varices,GV）出血是门静脉高压的严重并发症之一,由于出血迅猛危及患者生命,近几年来随着内镜技术的不断发展,内镜治疗取得令人鼓舞的效果。现就GV的内镜治疗作一综述。     

急诊内镜下套扎治疗胃静脉曲张出血

１９９４年５月始,我们采用内镜下曲张静脉套扎术治疗食管和／或胃静脉曲张出血（ＧＶ）患者,其中１３例ＧＶ出血患者套扎治疗取得了较好的疗效,现将结果报告如下： 一 临床资料：１３例ＧＶ出血患者中１０例以呕血入院,另 ３例则以黑便入院。其中男１１例,女２例,年龄２２岁至 ６８岁,平均４６岁,肝炎后肝硬化９例,酒精性肝硬化４例;肝功能Ｃｈｉｌｄ－Ｐｕｇｈ分级Ａ级７例,Ｂ级４例,Ｃ级２例。 急诊胃镜检查发现单纯ＧＶ４例,ＧＶ－Ｉ型３例,ＧＶ－Ⅱ型４例,混合型２例。其中ＧＶ喷血３例,渗血４例,红色或白色血栓形成…     

重视食管胃底静脉曲张的治疗北大核心CSCD

食管胃底静脉曲张与食管胃底静脉曲张破裂出血(esophageal-gastric variceal bleeding,EGVB)关系密切,后者是消化科中较为常见且极为凶险的肝硬化并发症,正确且有效地治疗与预防食管胃底静脉曲张尤为重要,其中最主要的手段即合理运用各类相关治疗方式包括药物、内镜、介入等,不断发展的技术对医师及医疗机构提出了更高的要求,不断学习、认识食管胃底静脉曲张,才能更加有效地针对其各类表现早期辨别、预防、治疗。     

三种内镜下治疗方法对胃底静脉曲张的疗效

目的 探讨3种内镜下治疗方法对胃底静脉曲张的疗效。方法 将40例胃底静脉曲张患者分为3组进行内镜下治疗，分别为胃底静脉曲张结扎术组(11例)、静脉内注射组织粘合剂组(15例)以及静脉内注射鱼肝油酸钠和凝血酶组(14例)。术后随访6个月，了解其有效率、胃底静脉曲张消失率、再出血率、不良反应发生率以及成本-效益比。结果 3组患者6个月的有效率分别为100．0％、100．0％、72．7％；胃底静脉曲张消失率分别为25．0％、30．8％、0；再出血率分别为27．3％、20．0％、28．6％。结论 胃底静脉曲张结扎术和静脉内注射组织粘合剂的疗效优于静脉内注射鱼肝油酸钠和凝血酶，胃底静脉曲张结扎术的成本-效益比最好。     

食管胃静脉曲张内镜治疗的最新进展

食管胃静脉曲张(esophagogastricvarices，EGV)出血是肝硬化门静脉高压症最凶险的并发症之一，防治EGV出血对于延长肝硬化患者的生存期至关重要。现简述近年来内镜诊治EGV的新进展如下。     

Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration

Although less common than oesophageal varices in portal hypertension, gastric fundal varices carry a higher mortality rate when they rupture. They are less amenable to sclerotherapy. We have developed a minimally invasive balloon-occluded retrograde transverse obliteration (B-RTO) procedure to treat gastric fundal varices. B-RTO involves inserting a balloon catheter into an outflow shunt (gastric-renal or gastric-vena caval inferior) via the femoral or internal jugular vein. Blood flow is then blocked by inflating the balloon, and 5% ethanolamine oleate iopamidol is injected in a retrograde manner. The embolized gastric varix subsequentlyl disappears. B-RTO was performed in 32 patients with gastric varices. Follow-up endoscopies were performed at intervals of 2–4 months for an average observation period of 14 months. Eradication of the varices has been confirmed in 31 of 32 patients. No recurrence occurred in any patients in the follow-up period. There were no significant changes in liver function after the procedure. We conclude that B-RTO is a safe and effective procedure for the treatment of gastric fundal varices.     

Management of gastric varices

Gastric varices (GV) area common (20%) accompaniment of portal hypertension; they are more often seen in those patients who bleed than in those who do not (27% versus 4%, p < 0.01). They can develop in both segmental and generalized portal hypertension. Depending on their location and relation with oesophageal varices, GVs can be classified as gastro-oesophageal varices (GOV) and isolated gastric varices (IGV); each of these can be further subdivided as follows: GOV1 (extension of oesophageal varices along lesser curve) and GOV2 (extension of oesophageal varices towards fundus); and IGV1 (varices in the fundus) and IGV2 (isolated varices anywhere in the stomach). The common presentation of GVs is variceal bleeding and encephalopathy. In comparison with oesophageal varices, GVs bleed significantly less often (64% versus 25%, p < 0.01) but more severely (2.9±0.3 versus 4.8±0.6 transfusion units, p< 0.01). Patients with GOV2 and IGV1 bleed more often than patients with other types of GVs. Sclerotherapy for oesophageal varices can significantly influence the natural history of GVs. GOV1, or lesser curve varices, disappear in the majority of cases (59%) after obliteration of oesophageal varices. In those with persisting GOV1, the incidence of bleeding and mortality is high and these patients require gastric variceal sclerotherapy (GVS). During oesophageal variceal sclerotherapy, bleeding can occasionally be induced from GVs. After obliteration of oesophageal varices, recurrence as GVs (secondary GVs) can occur in about 9% of patients. Emergency GVS is quite effective in controlling acute bleeding from GVs, more so than balloon tamponade. Potent sclerosants like tetradecyl sulphate and alcohol and a glue, bucrylate, have been quite effective. Elective GVS can achieve obliteration of GVs in nearly 70% of patients. Rebleeding and ulceration are common complications of GVS; probably related to incomplete obliteration and mucosal injury respectively. Splenectomy is quite effective in treating GVs due to segmental portal hypertension. For GV bleeding due to generalized portal hypertension, a shunt operation is often effective. TIPS procedure appear to be a very promising therapy for GV bleeding. Liver transplantation may be a superior alternative to sclero-therapy and shunt surgery for gastric varices.     

Management of gastric varices

Although the incidence of bleeding from gastric varices is relatively low (10%-36%), the bleeding is massive once it has occurred and it increases the patient's mortality. The management of esophageal variceal bleeding is highly differentiated with several effective treatments available. In contrast, bleeding from gastric varices continues to be a therapeutic challenge. In the last decade, there have been increasing reports regarding the management of gastric varices. In this article we review recent progress in the management of gastric varices and discuss further expected studies.     

Update on gastric varices

Although less common than oesophageal variceal haemorrhage, gastric variceal bleeding remains a serious complication of portal hypertension, with a high associated mortality. In this review we provide an update on the aetiology, classification and management of gastric varices, including acute bleeding, prevention of rebleeding and primary prophylaxis. We describe the optimum management strategies for gastric varices including drug, endoscopic and radiological therapies, focusing on recent published evidence.     

Sclerotherapy of gastric varices]

160 patients, 128 males, 32 females, with portal hypertension were admitted into our department for sclerotherapy from May 1987 to August 1990. Gastric fundus could be observed clearly in 145 of these patients who were examined with endoscope. Gastric varices were found in 105 of the 145 patients. Sclerotherapy of gastric varices were carried out in 47 of the 105 patients by intravenous injection with the method of lesser injection points and larger dosage. The results showed that a satisfactory effect was obtained with a rate of immediate stoppage of bleeding by 95.7%; and a rate of disappearance of gastric varices by 95.3%. The rate of recurrent bleeding was 7.9%. In addition, the occurrence rate, the severity, the manifestations under endoscopy and the classification of gastric varices as well as the indication, and complications of sclerotherapy of gastric varices were discussed in detail.     

Endoscopic classification of gastric varices

Endoscopic observations of gastric varices in 124 patients were classified according to form, location, and color. Form was classified into three types: tortuous (F1), nodular (F2), and tumorous (F3). Location was classified into five types: anterior (La), posterior (Lp), lesser (Ll) and greater curvature (Lg) of the cardia, and fundic area (Lf). Color was white (Cw) or red (Cr). Glossy, thin-walled focal redness on the varix was defined as red color spot (RC spot). Stepwise logistic regression analysis for multivariate adjustments was performed for all of the endoscopic covariates, and four risk factors (La, Lg, F2, RC spot) that affect bleeding from gastric varices were independently identified. This classification should aid in assessing gastric varices observed by fiberoptic endoscopy and help design appropriate treatment.     

Endoscopic management of gastric varices

Understanding the basic pathophysiology and anatomy of gastric varices is critical to the appropriate management of acute variceal bleeding. The high morbidity and mortality of gastric variceal bleeding combined with poor response to treatments for esophageal variceal bleeding has demanded a highly differentiated approach. This review focuses on gastric fundal varices for which the most recent Baveno VI consensus guidelines recommend endoscopic cyanoacrylate-based therapy as first-line intervention. We discuss the evolution of endoscopic techniques, not only to achieve effective hemostasis but also to limit inherent risks and complications. Long-term data reveal that low rebleeding rates are feasible when gastric varices are completely obliterated. Both primary and secondary prophylaxis should become part of standard treatment algorithms.