Biomedical subjects

H Yamaga

Publications and source records attributed to H Yamaga.

57 records · Page 4Linked to original sources

PubMedDate not supplied

Over-tube is preferable to free-hand technique to avoid recurrence of varices after endoscopic injection sclerotherapy. Prospective randomized trial.

One hundred and two patients undergoing sclerotherapy of esophageal varices, using 5% ethanolamine oleate, were randomly allocated to either the over-tube (O-T) or the free-hand (F-H) group, and 100 patients could be followed at monthly intervals for a period of 30.8 +/- 14.7 months (mean +/- SD) after the varices had been eradicated. Endoscopy performed one month after the final session of sclerotherapy revealed circumferential ulcers and scarring in the lower esophagus in 42 of 50 patients (84%) in the O-T group and in 16 of 50 patients (32%) of the F-H group, the difference being statistically significant (P less than 0.01). In the remaining 8 and 34 patients in the O-T and the F-H groups, respectively, a partly fibrotic residual mucosa was seen. There was a recurrence of the varices in the residual mucosa in 14 (28%) in the F-H group during the mean follow-up period of 25.6 months, while there were five patients (10%) with a recurrence of varices in the O-T group, the difference being statistically significant (P less than 0.05). The survival rates showed no statistical significance. Two patients in the F-H group had recurrent bleeding. We conclude that the over-tube technique of sclerosing esophageal varices reduces the rate of recurrence of the varices, in the long term follow-up, and after formation of a circumferential scarring in the lower esophagus.

Esophageal and Gastric Varices↗

PubMedDate not supplied

Gastric bleeding after endoscopic injection sclerotherapy for esophageal varices may be fatal.

Among 457 Japanese cirrhotic patients with esophageal varices, 28 (6%) bled from the upper gastrointestinal tract after the initial session of endoscopic injection sclerotherapy (EIS); 13 bled during the course of repeated EIS and 15 bled mainly from gastric lesions after eradication of the varices. Of these 28 patients, bleeding from gastritis occurred in 13 (46%), from esophageal varices in 10 (36%), from gastric varices in 4 (14%) and from gastric ulcer in one (4%). Six of 13 patients with gastritis-related bleeding and 3 of 4 patients with gastric variceal bleeding died of uncontrollable hemorrhage complicated liver failure, while 9 of 10 patients with esophageal variceal bleeding were controlled and reinjection was feasible. Ten (36%) of the 28 patients, with Child's grade B or C and severe ascites, died, mainly following bleeding from gastric lesions. This study shows that bleeding from gastric lesions after EIS can be uncontrollable and fatal in patients with poor liver function.

Esophageal and Gastric Varices↗

PubMedDate not supplied

Sclerotherapy superior to surgery for longer survival and less rebleeding in 103 cirrhotics with variceal bleeding.

In the ten years period from 1976-1986, 103 cirrhotic Japanese with acute variceal bleeding underwent either surgical treatment (48) or endoscopic injection sclerotherapy (55) at Kyushu University Hospital. We retrospectively analysed the clinical records of these patients. The two groups were comparable with regard to clinical condition and liver function, except for the higher rate of Child's C patients in the sclerotherapy group than in the surgical group (29 vs. 16; P less than 0.05). Control of variceal bleeding was attained in all of the 48 surgical patients and in 54 (98.2%) of the 55 sclerotherapy patients. Bleeding recurred in five (10.4%) of the surgical group and in one (1.8%) of the sclerotherapy group, resulting in four and one deaths, respectively, during the hospital stay. Mortality rates at 30 days and six months were 16.7% (8/48), 43.8% (21/48) in the surgical group, and 9.1% (5/55), 14.5% (8/55) in the sclerotherapy group. The five-year cumulative survival rate was significantly higher (P less than 0.01) in the sclerotherapy group (53.3%) than in the surgical group (29.4%). Therefore, in our patients sclerotherapy led to a longer survival with fewer rebleedings, as compared to other patients who underwent conventional surgical treatment.

Esophageal and Gastric Varices↗