Endoscopic variceal ligation-injection sclerotherapy (EVLIS) for gastric varices: Analysis of 10 years' experience / 대한내과학회지

BACKGROUND: The aim of this study is to evaluate the long-term clinical outcome, rebleeding rate, and recurrence rate of endoscopic variceal ligation injection sclerotherapy (EVLIS) for gastric varices. METHODS: 302 cases were chosen from patients treated with EVLIS for gastric varices from September 1992 to August 2002. The follow-up period ranged from 6 to 12 months with average being 35 months. RESULTS: The number of patients with gastric varices F1, F2, F3 were 105 (43.8%), 127 (42%), 70 (23.2%) and Lg-c, Lg-f, Lg-cf were 82 (26.9%), 67 (22.2%), 153 (50.9%). The average sessions of therapy needed for the initial hemostasis was 2.34 times. Initial hemostasis in 117 patients who needed emergency treatment was successfully done in all cases. Early rebleeding was observed in 36 (12%) patients in whom most of the bleeding occurred from the secondary ulcer. Late rebleeding was observed in 37 (12.2%) patients in whom secondary ulcer and gastric variceal bleeding accounted for rebleeding in 14 (4.6%) patients and 23 (7.6%) patients respectively. Within the follow-up period, recurrence of gastric varices was observed in 104 (34.3%) patients with the average time to recurrence being 18.8+/-16 months. CONCLUSION: Since our method shows similar results with that of long-studied esophageal variceal therapy, it is thought of as an excellent treatment modality for gastric varices.

An Analysis of Extravariceal Collaterals of Gastric Varices Using Magnetic Resonance Angiography in Portal Hypertensive Patients / 대한소화기학회지

BACKGROUND/AIMS: This study was aimed to analyze the relationship between gastric varices and its collaterals using magnetic resonance angiography (MRA) and to assess the usefulness of MRA in studies of portosystemic circulation. METHODS: Eighty-one patients who had portal hypertension with gastric varices took MRA before the therapy for gastric varices. RESULTS: The types of collaterals observed by MRA were left gastric vein in 67 patients (83%), short gastric vein in 28 (35%), gastrorenal shunt in 25 (31%), and splenorenal shunt in 14 (17%). In most of patients with advanced gastric varices, the size of left gastric vein was larger than others. In most cases of large gastric varices, the short gastric vein ranged between 5 to 10 mm. Gastrorenal shunt was also correlated with the size of gastric varices. The types of more prominent esophageal varices showed a right type (left gastric vein predominance), but the types of more prominent gastric varices or only the gastric varices showed a left type (posterior or short gastric vein predominance) (p<0.05). CONCLUSIONS: Gadolinium enhanced 3D-MRA can contribute to the study of the hemodynamic relationships between gastric vein and the collateral circulations by presenting more clear images for patients with portal hypertension.

Changes in portosystemic collaterals after endoscopic injection sclerotherapy: focused on magnetic resonance angiography / 대한내과학회지

BACKGROUND: This study was aimed at evaluating the changes of collateral circulation, using MR angiography (MRA), which is a non-invasive and a useful tool for viewing the porto-systemic circulation as a whole, following endoscopic injection sclerotherapy (EIS). METHODS: 30 patients who have portal hypertension with esophageal varices have taken MRA before the sclerotherapy and followed up 1 month after the eradication. RESULTS: The collaterals observed before EIS are as follows: left gastric vein 30 patients (100%), short gastric vein 2 patients (7%), gastro-renal shunt 2 patients (7%) and spleno-renal shunt 6 patients (20%). After the sclerotherapy, left gastric vein was obliterated in 12 patients (40%), decreased to 25% and 50% in 9 patients (30%) but, no change in 6 patients (20%), increased in 3 patients (10%). For short gastric vein, 25% and 50% size reduction was found in 2 patients. For gastro-renal shunt, no change in size was observed in 1 patient, increased to 25% in 1 patient. For spleno-renal shunt, it disappeared in 1 patients (17%) and decreased to 25% in 1 patient but, no change in 3 patients (50%), increased to 25% in 1 patients. CONCLUSION: Obliteration of left gastric vein was observed in many cases after the sclerotherapy and further evaluation is needed.

Pyoderma Gangrenosum on the Sternal Area in Ulcerative Colitis / 대한소화기내시경학회지

Pyoderma gangrenosum is a painful, chronic, ulcerative skin disease of unknown cause. It commences as an erythematous papulopustule and rapidly evolves to form an area of frank ulceration with undermined, violaceous edges and a bright outer halo of erythema. An underlying systemic illness is present in more than 75 per cent of patients. Inflammatory bowel disease, either ulcerative colitis or Crohn's disease, is the most frequent. Pyoderma gangrenosum generally appears during the course of active bowel disease and frequently concur with exacerbations of colitis. However, they also occur in inactive colitis. Nor is there general agreement regarding the relationship between the duration, activity, and extent of bowel disease and the incidence and severity of the skin lesions. We experienced a case of pyoderma gangrenosum developed on the sternum with inactive ulcerative colitis and improved with corticosteroid, antimicrobial agents and topical dressing but recurred another site with active colitis.