Diagnosis of Esophageal Varices: especially its endoscopic diagnosis M. Sesoko 1 , T. Naruke 1 , A. Kawakami 1 , Y. Ota 1 , K. Kasugai 1 , K. Tsuneoka 1 13rd Dept. of Int. Med., Nippon Medical School pp.1313-1320
Published Date 1972/10/25
DOI https://doi.org/10.11477/mf.1403109070
  • Abstract
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 For the past 20 years Brick,Palmer and Dagradi have urgently stressed on the need of propagating endoscopy for the diagnosis of esophageal varices, which was a relatively neglected procedure. In recent years we have done a total of 126 fiber esophagoscopic examinations for 104 cases of esophageal varices, with no unexpected complications.

 Varices of the esophagus were seen in 82 per cent of liver cirrhosis, but they were also observed in such other diseases as chronic hepatitis, fatty liver, metastatic carcinoma of the liver, toxic hepatitis and obstructive jaundice.

 We have attempted to establish the criteria for the severity of esophageal varices by dividing it into three stages. We have also studied the relationship between endoscopic findings of varices and changes of pressure within the esophagus. It was noted that endoscopic pictures of the esophagus greatly vary in accordance with changes of pressure within it.

 X-ray diagnosis was hard to arrive at in varices of slight degree. Endoscopy was most effective for them. For such an examination it is most important to see to it that the amount of air should be barely adequate for endoscopy with resultant lowered pressure within the esophagus. Pressure of the peripheral blood vessels within the submucosa by means of a cursor equipped at the tip of fiberesophagoscope emphasizes any possible finding. Neither the use of esophagoscope with cuffs attached, intravenous injection of color materials, nor co-employment of Valsalva's method proved of no avail for our purpose.

 Some relationship was seen between varices and clinical symptoms of liver cirrhosis, but no connection was found between varices and such findings as enlargement of the liver, edema, plasma gamma globulin and BSP level. On the other hand, varices were slightly related with spleen enlargement. The severity of varices was also found to be closely connected with venous stasis in both the ligamentum teres of liver and the parietal peritoneum.

Copyright © 1972, Igaku-Shoin Ltd. All rights reserved.


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