Clinical and pathological studies of cases with long term survival after endoscopic injection sclerotherapy eis for esophageal varices
Wada, A.; Sato, H.; Kato, K.; Yamada, S.; Tokumitsu, S.; Onishi, H.; Kimura, T.; Kobayashi, T.; Ito, J.
Kawasaki Igakkai Shi 16(3-4): 256-263
From among 68 cases of EIS treated with 5% ethanolamine oleate (EO), we examined 11 who had survived for at least three years postoperatively. EIS was emergent, palliative and preventive in two, three and six cases respectively. In all cases, the underlying disease was hepatocirrhosis non-complicated with liver cancer. (3, 8 and 0 cases of Child A, B, and C, respectively, according to the Child classification). Of these 11 cases, 9 received 1 to 3 EISs by intravariceal injection. Varices were completely eradicated and recurrence of the disease was not noted for over three years. Of the nine cases, two died of liver failure. In one case on which an autopsy was performed, the varice were shown to be completely organized. Of the 11 cases, 2 received EISs by intravariceal injection, which resulted in complete eradication of the varices. Later recurrence of a varix showing an atypical red-color sign was observed. Four to seven EISs were done mainly by paravariceal injection in two cases and prevented death from bleeding from varices for over three years. In these two cases, one died of liver failure. Histologically, a high degree of lamina submuscosal fibrosis and organized varices were noted, but the veins of the lamina propria mucosa were shown to dilated in part and unorganized, which it was suggested corresponded to the atypical red-color sign of the endoscopic findings. The above results led us to the following conclusions: 1) Organization of all varices obtained by intravariceal injection made long-term survival possible. 2) Repetitive EIS of cases for post-EIS recurrence is required for their long-term survival.