식도정맥류 출혈의 내시경적 결찰요법의 임상적고찰 = Clinical Evaluations for Endoscopic Variceal Ligation in Esophageal Varices Bleeding

다국어 초록 (Multilingual Abstract)

Endoscopic infection sclerotherapy(EIS) has been shown to be the most effective simple method for control of bleeding and eradication of varices. This method has been accepted widely as a standard treatment of bleeding esophageal varices. However, EIS may be associated with undesirable local and systemic complications.
Endoscopic variceal ligation(EVL) was first described in 1986 by Stiegmann et al, which consists of mechanical ligation and thrombosis of varices using elastic $quot;0$quot;-ring. EVL has been shown to control active bleeding and to eradicate varices when sessions are repeated.
The purpose of this study was to compare with change of esophageal variceal form, with respect to safety, efficacy and complications of EVL in the each sessions. We performed EVL in 43 patients who had recently bled from esophageal varices. Total 679 variceal ligations were performed during 174 separyte EVL sessians. Eighteen(94.7%) of those actively bleeding(19 patients) at initial treatment had bleeding controlled at initial session. During the study period two patients died after 1st and 3rd session, one who died from aggravation of concomitant hepatoma with rebleeding, the other died from early massive rebleeding after 3rd session. Rebleeding, before eradicates varices, occured in 7 patients(16.3%) two patients had bled from varices with aggravation of concomitant hepatoma, other 2 patients had bled from early varices ligation, other 3 patients had bled from re-varices formation in fundus of the stomach. Varices were eradicated or reduced to F₁ in 36 patients(87.8%) of the 41 follow up patients. Each patient received mean 15.8 ligations and 4.1 sessions during the 1st to 6th sessions. Eradication rate of varices(F_0) has increased from the 3rd to the 4th session periods. Improvement rate of varices(F₁) has increased from the 1st to the 3rd session periods. During the 5th or the 6h EVL sessions, eradication and improvement rate of esaphageal varices has been shown to decreased. During or after EVL, there were no major complications, except mild chest discomfort in 6 patients, early bleeding in 2 gatients, mild dysphagia in one patient of 43 patients.
According to this study, EVL appears to control active variceal bleeding and eradicate varices with repeat treatments. It is a safe and effective treatment for esophageal varices bleeding. We recommended EVL as an alternative to EIS over the 5th sessions.