1.食道・胃静脈瘤

Endoscopic Management of Esophagogastric Varices

要旨　食道・胃静脈瘤は上部消化管出血の主要な出血源であり，出血により肝不全を来したり，大量出血では致命的となる．出血時の緊急内視鏡検査による診断は極めて重要であり，直ちに内視鏡治療による緊急止血を可能とする．いまや，静脈瘤治療は多様化し，病態に応じた適切な治療法を選択できるようになった．したがって，静脈瘤治療は安全かつ効果的で，患者のQOLの向上が得られる手技であることが要求される．そのためには，1つの手技に固執することなく，患者の全身状態や肝障害の程度，門脈血行動態に応じた適切な治療法の選択と併用が重要である．

　Esophageal and gastric varices are a main cause of upper gastrointestinal bleeding, and will bring about liver failure after variceal hemorrhage. Thus, massive hemorrhage results in poor prognosis.

　The diagnosis of variceal bleeding by urgent endoscopy is very important. Moreover, active bleeding from varices can be completely treated by endoscopy.

　Nowadays, we have many methods of treatment for variceal bleeding, and are able to choose the appropriate treatment according to the clinical condition of the patient.

　Safe and effective treatment is necessary and it can bring about improvement in quality of life. There is no need to persist with one procedure. If it is ineffective, another procedure can be used. For patients with esophageal and gastric varices it is important to select the treatment most appropriate for the general condition and portal dynamics of the patient.