食道静脈瘤に対するEVL・マイクロ波凝固法併用療法の長期予後

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  • Long-term Evaluation of Combination Therapy of Endoscopic Variceal Ligation and Microwave Coagulation for Esophageal Varices

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Endoscopic variceal ligation (EVL) without additional therapy is reported to show high recurrence rate in early period afte treatment. To reduce this high recurrence rate, we introduced the combination therapy of EVL and microwave coagulation (MWC) for esophageal varices in 1994. At first, EVL is performed for eradication of esophageal varices. After disappearance of variceal forms, MWC is added for mucosa-fibrosing therapy. MWC is conducted with an output of 40 Watt and a duration of 5 s. Endpoint of EVL-MWC combination therapy is until we confirm endoscopically the complete disappearance of variceal forms by EVL and the circular ulceration of lower esophageal wall by MWC. Since March 1994 to December 1999 we have performed EVL-MWC combination therapy in 126 patients with liver cirrhosis in our medical center. In this study, to evaluate the efficacy of EVL-MWC combination therapy, we investigated shortand long-term results, incidence of complications, and prognosis of the patients who had undergone this combination therapy. Till achievement of endpoint, the average sessions of EVL-MWC combination therapy was 2.9 times and the average days of treatment was 25.6 days. No major complications and no severe side effects were found during and/or after EVL and MWC treatments. Over all the RC sign recurrences were recognized in 27 patients (21.4%) during 6 years following up period after EVL-MWC combination therapy. The average period of recurrence was 462.7 days. Recurrent bleeding occurred in 5 patients (4%). We concluded that EVL-MWC combination therapy was easy and safe, and had long-term efficacy for esophageal varices.

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