Hiroshi Miyoshi

Endoscopic Clipping of Esophageal Varices

Abstract: A new method of endoscopic therapy for esophageal varices using a clipping apparatus was devised and applied prophylactically in nine patients with esophageal varices which were not bleeding. Eighty two ligations were placed in 21 separate treatment sessions in this study. All the esophageal varices were eradicated or reduced in size and length within 2 months following treatment. No major complications such as massive bleeding, the development of deep esophageal ulcers, esophageal perforation, esophageal stenosis and pleural effusion developed. The follow‐up period ranged from 6 months to 18 months. Three patients (33%) were re‐treated by the same method because of the regrowth of esophageal varices during this period, but no bleeding occured in these patients. It seems that this newly developed method is a safe, simple and effective technique for the treatment of esophageal varices.

A Clinical Study on Mucosal Circulation of Cervical Anastomotic Portion after Esophageal Reconstruction.

食道手術後頸部食道胃管吻合部およびその周囲の粘膜面組織血流量について主として良性吻合部狭窄発生との関係を中心にendoscopic laser-Doppler flowmetryを用いて臨床的検討を加えた, 対象は食道に異常を認めなかった健常者 (対照群) 24例と, 胸部食道癌で過去に食道切除後胃管にて再建術を受けた14例とした. 健常対照群では胃穹薩部, 腹部・胸部・頸部食道すべてにおいて26 (単位ml/min/100g, 以下同じ) 以上の良好な血流の存在が確認された. 一方, 食道手術後群では胃管先端 (旧胃穹窪部), 吻合部, 頸部食道の粘膜面組織血流量はすべて25以下の低値を示した. さらに食道術後群を吻合部狭窄の有無により2群にわけると吻合部の粘膜面組織血流量は吻合部狭窄 (-) 群で25, 吻合部狭窄 (+) 群で10と吻合部狭窄 (+) 群で有意に低値を示し, 頸部食道良性吻合部狭窄発生と粘膜面組織血流量の低値との相関性が示唆された.