Management of bleeding esophageal varices--efficacy of emergency embolization therapy
Tajiri, T.; Onda, M.; Umehara, M.; Yoshida, H.; Yamashita, K.; Kim, D.Y.; Mamada, Y.
Nihon Geka Gakkai Zasshi 90(9): 1541-1544
1989
ISSN/ISBN: 0301-4894 PMID: 2586462 Document Number: 331052
To increase durability for long term control of bleeding, additional treatment has to be performed. Since Oct. 1979, various embolizations that is percutaneous transhepatic obliteration (PTO), splenic artery embolization (SAE) and left gastric artery embolization (LGE) were introduced as conservative treatments, and have been used singly or concomitantly. Embolization has been employed in order to avoid the high risk of emergency operation. Complete hemostasis and prolonged efficacy could be obtained by introducing various embolizations. No emergency operation has been performed since all of these embolizations were introduced in Jan. 1983. The rates of hemostasis (100%), one month survival (90%), 1 year incidence of rebleeding (6.7%), 1 year survival (75.5%) and 3 year survival (62.5%) of emergency cases which received combined embolizations were better than the results of the cases which received emergency operation or endoscopic sclerotherapy alone. Moreover, the patients with gastric varices, including bleeding gastric varices treated with various combined embolizations, showed results of diminished varices in 78.9% of the patients. Thus to increase durability for long term control of bleeding, embolization should be combined according to the patient's hemodynamics, which may result in its extended application.