A clinical evaluation of endoscopic treatment for esophago-gastric varices in hepatoma patients with tumor invasion in the portal vein trunk or first portal branches (Vp3) was carried out. 1) Efficacy of endoscopic treatment for varices : Variceal bleeding in emergent and elective cases was controlled in 91% of 19 patients with Vp3 portal invasion and in 94% of 38 patients without Vp3 portal invasion (N.S.). Re-bleeding was observed in 50% and 30% of these patients (N.S.), and death due to variceal bleeding occurred in 53% and 23% (p<0.05), respectively. Variceal bleeding in prophylactic cases was observed in 33% of 9 patients with Vp3 portal invasion and in 14.5% of 140 patients without Vp3 portal invasion (N.S.), and death caused by variceal bleeding was recorded in 22% and 3.3% (p<0.05), respectively. 2) Efficacy of prophylactic treatment for varices : Variceal bleeding in patients with Vp3 portal invasion was observed in 33% of 9 patients receiving prophylactic treatment and in 74% of 35 patients without prophylactic treatment (p < 0.05), and death due to variceal bleeding occurred in 22% and 49% (N.S.), respectively. Variceal bleeding in patients without Vp3 portal invasion was observed in 14% of 140 patients receiving prophylactic treatment and in 84% of 51 patients without prophylactic treatment (p < 0.001), and death due to variceal bleeding occurred in 3.3% and 27% (N.S.), respectively. We concluded that, 1) every effort should be made to avoid bleeding after endoscopic treatment because of the high incidence of variceal bleeding in patients with Vp3 portal invasion, 2) prophylactic treatment could decrease incidence of variceal bleeding in patients with Vp3 portal invasion, and could also decrease the incidence of variceal bleeding and of death due to bleeding in patients without Vp3 portal invasion.

View full abstract

Aim : Portal vein thrombosis (PVTT) is a life shortening complication for patients with liver cirrhosis (LC) accompanied with hepatocellular carcinoma (HCC). We investigated the therapeutic effect of selective transcatheter arterial embolisation with Lipiodol emulsion (Lp-TAE) on PVTT developed in patients with LC and HCC, and esophagogastric varices (EGV). Subjects and methods : Subjects consisted of 8 patients with LC and HCC, and PVTT. The causes of LC were HCV in 5, HBV in 2 and HCV+HBV in 1 patient. Mean age was 55.6±8.5 years old. Lp-TAE was targeted to hepatic arteries forming the “thread and streak sign.” Changes in the severity of EGV and liver function, and patient outcome were investigated. Results : The severity of EGV did not change after Lp-TAE. Liver functions estimated by Child-Pugh score deteriorated (from 6.63± 1.30 to 7.50±2.00). Mean life-span after Lp-TAE was 36.5 months. One, three and five year survival rates were 87.5%, 70% and 52.5%, respectively. The causes of death were hepatic failure in 2 and a complicating disease in 1. Conclusion : Lp-TAE for PVTT in patients with LC and HCC, and EGV dose not worsen EGV and may be effective in prolonging survival, especially in patients without severe liver dysfunction. Therapy for PVTT is the first choice in patients with EGV and HCC accompanied with PVTT.

View full abstract

We performed endoscopic injection sclerotherapy or endoscopic injection sclerotherapy with ligation in the treatment of 21 patients with esophageal variceal bleeding due to portal trunk and/ or main branch invasion of hepatocellular carcinoma (Vp3 HCC). Acute bleeding was controlled in 19 of 21 patients (90%), rebleeding occurred in 7 of 19 patients (37%), and only 4 patients died of variceal bleeding. Mean survival time was 91 ± 80 days (range, 3 to 232 days), and 8 patients with jaundice and/or uncontrollable ascites at the time of treatment died within 6 weeks, usually because of liver failure. The cumulative survival rate in the treated group was not significantly different from that in the patients who did not develop bleeding despite presenting with Vp3 HCC and red color sign positive esophageal varices. It is suggested that emergency endoscopic treat-ment, even in cases of Vp3 HCC, is effective for controlling esophageal variceal bleeding and can promote survival similar to that in the non-bleeding group.

View full abstract

We investigated the relationship between quantitative evaluations of splenic imaging on ^99mTc-GSA liver scintigraphy and portal hypertension. The index of splenic imaging (S3/L3), which represents the count ratio for the spleen to the liver 3 minutes after injecton of the tracer, was estimated in 58 cases of chronic liver disease. Portal hypertension was evaluated by examination of esophagogastric varices and collateral veins. S3/L3 was increased in cases of collateral veins (p=0.063). With regard to collateral flow patterns, S3/L3 was not increased in cases showing descending collaterals only, but was increased in cases showing ascending collaterals. S3/L3 was significantly increased in cases of varices (p=0.018). Endoscopic evaluation of varices did not reveal any correlation between form and red color sign of varices and S3/L3. It is suggested that the level of portal hypertension may be precisely evaluated by quantitative splenic imaging on ^99mTc-GSA liver scintigraphy.

View full abstract

The purpose of this study is to evaluate MR angiography for portal hypertension. Breath hold three-dimensional Gadolinium-enhanced MR angiography was performed in 15 patients with portal hypertension (13 patients with liver cirrhosis, 2 patients with idiopathic portal hypertension). MR angiography could depict varicose veins, shunt, afferent routes and efferent routes. In nine of 15 cases, X-ray angiography was performed. In 9 patients, MR angiography depicted these collateral vessels more clearly than angiography. Furthermore, MR angiography could estimate the improvement of varices and collateral vessels after interventional radiology (IVR). MR angiography depicted afferent and efferent routes clearly (especially tiny routes, inferior phrenic vein), and could be performed easily and noninvasively. MR angiography, provides an alternative to X-ray angiography for preoperative and/or postoperative planning for IVR such as transjugular intrahepatic portosystemic shunt, balloon occluded retrograde transvenous obliteration, and so on.

View full abstract

[in Japanese]

View full abstract

Hassab's procedure was performed after endoscopic injection sclerotherapy (EIS) in 35 patients with recurrent or newly appearing esophago-gastric varices. Thirty-four of 35 patients had esophageal varices and one patient had gastric varices before the initial EIS. Recurrent varices were esophageal varices in 5 patients, esophago-gastric varices in 24 and gastric varices in 5. The remaining patient did not have varices, but had severe hypersplenism. After Hassab's procedure, residual esophageal varices were detected in 16 patients. However, these varices disappeared after additional EIS. In 14 cases, gastric varices developed after EIS for esophageal varices. Gastric varices disappeared after Hassab's procedure in all cases. Hassab's procedure after EIS is effective for esophageal and gastric varices because of its effect in reducing the blood supply.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract