Hogen Tei

Long-term prognosis of esophageal variceal cases treated with injection sclerotherapy

SummaryOne hundred fifty-two patients with esophageal varices underwent a total of 485 injection sclerotherapy procedures (mean, 3.2 times per each case). During 5 years of observation, 20 cases (13.2%) died following injection sclerotherapy. The 3-year survival rates, based on the Kaplan-Meier method, were 42% for emergency cases, 75% for elective cases and 90% for prophylactic cases. Significant differences (P<0.05) by the generalized Wilcoxon test were observed in the survival rates between emergency cases and prophylactic cases, and also between elective cases and prophylactic cases. Two cases (8.6%) of failure to control acute hemostasis were experienced. Twenty cases of bleeding after sclerotherapy were experienced, and 8 died of bleeding. The three-year bleeding rate according to the Kaplan-Meier method was 59% for emergency cases, 25% for elective cases and 7% for prophylatic cases. A significant difference (P<0.05) by the generalized Wilcoxon test was observed in the bleeding rate between elective cases and prophylactic cases. Non-bleeding rate (100%-bleeding rate) after sclerotherapy showed almost the same values as the survival rate. These results indicate that upper digestive tract hemorrhage influences the prognosis of patients after sclerotherapy.

A Case of Early Gallbladder Carcinoma Associated with the Anomalous Union of the Pancreaticobiliary Ductal System

Abstract: A 68 year‐old woman was admitted to our hospital with a high fever. Ultrasonography revealed the presence of two protruded mass lesions in the fundus of the gallbladder. Endoscopic retrograde choledochopancreatography (ERCP) indicated an anomalous union of the pancreaticobiliary ductal system (AUPD), with an anomalous junction heated at the site 30 mm proximal to the ampulla of Vater. ERCP also showed the presence of three flat elevated lesions at the fundus of the gallbladder. Amylase activity in the bile obtained from the common bile duct during ERCP was high. From these findings, gallbladder carcinoma associated with AUPD was suspected. Cholecystectomy, choledochectomy followed by hepaticojejunostomy were performed on this patient. A microscopic study of the resected gallbladder demonstrated adenocarcinoma with epithelia like intestinal metaplasia in those elevated lesions surrounded by mucosa associated with atypical hyperplasia without intestinal metaplasia. The authors believe that intestinal metaplasia is the main change accompanied by the cancer, but atypical hyperplasia was an important pre‐cancerous lesion in this case.