Current strategy for esophageal varices in Japan

Esophageal varices (enlarged, swollen and tortuous veins at the lower end of the esophagus) and life-threatening variceal bleeding may be caused by portal hypertension, liver cirrhosis (degenerative disease in which liver tissue is replaced by fibrous tissue and fatty deposits), schistosomiasis (infection with a parasite transmitted to humans by water contaminated by feces), or hepatic (liver) obstruction. In Japan the most frequently used treatment modality for both emergency and elective cases of esophageal varices is sclerotherapy. Other methods of treatment include tamponade (use of pressure to stop bleeding); endoscopic sclerotherapy (injection of a sclerosing, or hardening, agent directly into esophageal varices using an illuminated optic instrument to see into the esophagus); devascularization (interruption of the circulation of blood to the bleeding point); and shunts (surgical procedures which divert the blood supply away from the area of bleeding). In Japan shunt operations are performed on 20 percent of cases of bleeding esophageal varices. Treatment of esophageal varices prophylactically (before bleeding occurs) is commonly performed in Japan. Factors that influence the decision regarding either surgery or sclerotherapy include: patient age less than 65 would favor surgery; elective treatment favors surgery, and emergency treatment, sclerotherapy; nature of the underlying liver disease; liver function and distribution of collateral vessels. (Consumer Summary produced by Reliance Medical Information, Inc.)