| The reason for the development of portal hypertension is that the portal venous pressure increases over the normal upper limit. The formation of portalsystemic collateral circulation decreases the pressure of portal circulation but results in the development of varices. Because of the high risk of bleeding and rebleeding and the high bleeding-related mortality, the gastroesophageal varices is paid attention to in the clinical practice. With the development of endoscopic treatment technique and device, endoscopic therapy has already become an important and effective therapeutic tool for gastroesophageal varices. For the treatment of esophageal varices, endoscopic sclerotherapy was used earlier than ligation therapy. But more and more trials has confirmed that ligation may be more effective and safe than sclerotherapy. There is no final conclusion at present whether the combination of ligation and sclerotherapy is preferable when comparing with each of them. The incidence and bleeding rate of gastric varices are both lower than that of esophageal varices, but it is usually severe when gastric varices bleeding occurs. Although there are studies about ligation or sclerotherapy used to treat gatric varices, tissue glue is still the preferable one in most parts of the world.Objectives:1 Analyze retrospectively the information of detecting and treating gastroesophageal varices in the Endoscope Laboratory of The Second Hospital of Hebei Medical University from 2006 to 2010. Observe the endoscopic methods for gastroesophageal varices and their effectiveness.2 Investigate the effect of endoscopic therapy of esophageal varices on gastric varices and portal hypertensive gastropathy.Methods:1 Search all the patients whose diagnosis included varices from 2006 to 2010 in the Endoscope Laboratory of The Second Hospital of Hebei Medical University.2 Find out the objects who had gastroesophageal varices according to the endoscopic results. Distinguish the patients on the basis of return visit number, name, sex, age, admission number and so on. There were totally 1079 patients who had gastroesophageal varices during the period.3 Screen all the patients who had ever undergone endoscopic varices treatment among the 1079 objects. Count the number of patients who underwent endoscopic therapy once, twice, three times or more than three times respectively.4 Count the number of times of all the endoscopic treatments of gastroesophageal varices and the number of times of different endoscopic methods during the five years.5 Among the patients who acceptted endoscopic esophageal varices ligation therapy, count the number of times of different bands used per session and the number of patients who received ligation therapy once, twice, three times or more than three times respectively. Handle the patients who accepted esophageal varices sclerotherapy and who were treated by injection of tissue glue into gastric varices in the same way.6 Divide the patients who underwent endoscopy again after an endoscopic treatment into four groups, esophageal varices ligation group, sclerotherapy group, combination of ligation and sclerotherapy group and gastric varices tissue glue injection group. Count the number of patients whose varices lessened, disappeared or had no change after endoscopic therapy respectively in the four groups and assess the effectiveness of each group.7 Observe the incidence and development of gastric varices and portal hypertensive gastropathy after endoscopic treatment of esophageal varices.Results:1 There were 1079 patients who had gastroesophageal varices in the Endoscope Laboratory of The Second Hospital of Hebei Medical University from 2006 to 2010. Among those patients, 252 objects underwent endoscopic treatment, 176 males and 76 females, with an average age of 53.71±12.77.2 The times of endoscopic gastroesophageal varices treatment were 25, 96, 44, 74 and 154 respectively during the five years, with a total number of 393. The number of patients who received endoscopic therapy once is 166, twice 60, three times 14, and more than three times 12.3 There were 264 times of esophageal varices ligation therapy, 89 times of esophageal varices sclerotherapy, 7 times of combination of ligation and sclerotherapy during the five years. The numbers of different endoscopic methods for gastric varices were tissue glue 36 times, ligation 6 times, sclerotherapy 16 times.4 In the esophageal varices ligation treatments, the most common number of loops used per session is 6, with the number of times of 190. In the patients who acceptted ligation therapy, most people were treated once, with 162 patients.5 In the esophageal varices sclerosis treatments, the volume of sclerosing agent used per session was mainly 20-30ml, with 77 times. In the treatments of injection of tissue glue into gastric varices, the volume of tissue glue injected per point was mainly 1-1.5ml, with a total number of 24 points. There were 31 times of endoscopic therapies with one point injected, and 5 times with two points injected. The number of patients who received tissue glue injection therapy once was 30, and twice was 3.6 The effective rates of esophageal varices ligation therapy, sclerotherapy, combination therapy and tissue glue injection therapy for gastric varices were 86.36%, 66.67%, 93.75% and 71.43% respectively. In the ligation group, the effective rate of using≤6 loops per session was 87.14%, and the rate of using﹥6 loops per session was 83.33%.7 20.75% of the patients who had no gastric varices before endoscopic treatment developed gastric varices after esophageal varices ligation therapy, and the rate was 42.86% in combination group. The rates of aggravated gastric varices in the patients who were with gastric varices before treating were respectively 14.29%, 36.36% and 11.11% after esophageal varices ligation, sclerotherapy and combination therapy.8 The rates of worsing portal hypertensive gastrophy were respectively 30.68%, 41.67% and 50.0% after the above three endoscopic methods.Conclusions:Ligation and sclerotherapy are both effective methods for esophageal varices and combination of the two methods may improve the effectiveness of endoscopic treatment of esophageal varices. Adding the number of ligation loops used per session can not improve the effectiveness of endoscopic esophageal varices ligation. Injection of tissue glue is an effective approach for treating gastric varices. Endoscopic therapy of esophageal varices might increase the incidence and development of gastric varices and portal hypertensive gastropathy. |
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