Comparison of endoscopic with interventional radiologic therapy for gastric varices

DOI
  • Kojima Seiichiro
    Division of Gastroenterology, Department of Internal Medicine, Tokai University Hachioji Hospital
  • Arase Yoshitaka
    Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine
  • Takashimizu Shinji
    Division of Gastroenterology, Department of Internal Medicine, Tokai University Hachioji Hospital
  • Kagawa Tatehiro
    Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine
  • Shiraishi Koichi
    Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine
  • Mine Tetsuya
    Division of Gastroenterology, Department of Internal Medicine, Tokai University School of Medicine
  • Koizumi Jun
    Department of Radiology, Tokai University School of Medicine
  • Makuuchi Hiroyasu
    Division of General Surgery, Department of Surgery, Tokai University Hachioji Hospital
  • Watanabe Norihito
    Division of Gastroenterology, Department of Internal Medicine, Tokai University Hachioji Hospital

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  • 胃静脈瘤に対する内視鏡治療とIVR治療の比較

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Abstract

Effect of endoscopic therapy was compared with interventional radiologic (IVR) therapy on gastric varices (GV) using 99 patients with GV. Of these, 55 patients were selected for endoscopic treatment, 34 were selected for IVR therapy and 10 were selected for the combination of both treatment. Among them 51% of the patients received prophylactic, 36% received emergent, and 13% received electic treatment.<br> Disappearance rates of GV after treatment were both comparably high at 94.5% in patients receiving endoscopic therapy and 91.2% in patients receiving IVR therapy, respectively. The recurrence-free interval was significantly longer in the prophylactic cases than the other cases (p < 0.05). In the prophylactic cases the recurrence-free period was significantly longer in patients who underwent IVR therapy than those who received endoscopical treatment. (p < 0.05: hazard ratio, 5.8).<br> In the emergent and elective patients a recurrence-free interval was significantly shorter in those who required blood transfusion than those who didn't (p < 0.05, hazard ratio, 4.2).<br> Survival time was significantly shorter in patients who were complicated with hepatocellular carcinoma (p < 0.0001; hazard ratio, 11.5) and in patients with poor hepatic function (p < 0.0001; hazard ratio, 7.8). There was no significant difference in the survival time between the two treatments in currently bleeding patients, suggesting that either therapy can be selected in such cases. Proplylactic IVR therapy before the worsening of hepatic function may attain a longer recurrence-free period.

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