2)胃静脈瘤

Endoscopic Treatment of Gastric Varices

要旨　胃静脈瘤の内視鏡治療では患者の生命に密接にかかわることが多くインフォームドコンセント（IC）は特に重要である．筆者らが行っているICの実際と，胃静脈瘤の内視鏡治療の現状を中心に述べた．ICにおいては，治療の必要性，治療により起こりうる偶発症の説明およびその対処の仕方を説明し，患者の病態に合わせて，実際に静脈瘤の血行動態の模式図を書いて説明している．胃静脈瘤の内視鏡治療はcyanoacrylate系組織接着剤による硬化療法，EVL，EIS，EISL，EVLs＋EISLがその中心であり，それらの使い分け，成績等を紹介した．

　Informed consent (IC) is especially important before the endoscope treatment of the gastric varices. The procedures about which IC is requested are described as follows.

　The aim of the treatment of spurting bleeding from gastric varices is, firstly, to bring about hemostasis and finally to prevent re-bleeding. Although endoscopic treatment is the first choice now, balloon occluded retrograde transvenous obliteration (B-RTO) is also becoming widely used along with interventional radiology. As an endoscopic treatment, the EVLs＋EISL method using a detachable snare and injection sclerotherapy using cyanoacrylates are both useful for the hemostasis of bleeding gastric varices. EVL is useful for bleeding from cardiac small varices on the lesser curvature.

　It is important to completely obliterate gastric varices to prevent re-bleeding or recurrence.