食道・胃静脈瘤の内視鏡的硬化栓塞療法―ETP法の実際と予後

Endoscopic Sclerothrombotherapy for Esophageal Varices: Technique and Long Term Follow-up of ETP Method

要旨　近年，食道・胃静脈瘤に対する内視鏡的硬化栓塞療法が普及し，緊急止血のみならず，持続的な静脈瘤消去効果も期待しうるものとなっている．われわれは1983年から無水アルコール，ヒトトロンビン，1％Aethoxysklerolを血管内に注入するETP法を行っており，現在までに183例（723回）に施行した．緊急止血率は93.8％であり，158例86.3％がほぼ完全に静脈瘤の消失をみた．肝不全で死亡したものは8例4.4％である．嚥下困難感や軽度の疼痛などのほか，重症合併症はない．長期予後をみると，6か月後に軽度の静脈瘤が再発したものが4.7％，12か月で8.9％であり，再出血を来したものは2例である．まだ問題点は残っているが，将来，内視鏡的硬化栓塞療法が食道・胃静脈瘤の治療の第一選択となると確信している．

　Recently, endoscopic sclerothrombotherapy for esophago-cardiac varices is becoming increasingly popular in Japan. This therapeutic method is effective not only for emergency hemostasis, but also for permanent elimination of the varices. In 1983, we commenced new sclerothrombotherapy using anhydrous alcohol, human thrombin and 1% Aethoxysklerol. This is called the ETP method. This procedure has been carried out a total of 723 times in 183 cases. The rate of hemostasis for emergency cases was 93.8% and 158 cases of them (86.3%) resulted in almost complete disappearance of varices. Only 8 cases, 4.4%, died of hepatic failure after bleeding.

　Concerning complications, mild pain or dysphagia was seen in about 50% of cases, but no other severe complications were seen. As for the long term follow-up, about 4.7% of them recurred low grade varices after six months and only 8.9% after 12 months. Rebleeding occurred in only tow cases.

　The authors feel that endoscopic sclerothrombotherapy will be the first choice for the treatment of esophago-cardiac varices in the near future, but some problems still remain to be solved.