業績報告 【publish】永島一憲 先生 Healthcare誌
永島一憲先生の論文が、Healthcare (Journal Citation Reports Impact Factor 2021 = 3.160)にpublishされました。
Healthcare (Basel). 2022 Jun 26;10(7):1193. doi: 10.3390/healthcare10071193.
The Risk of Bleeding in Small/Straight Esophageal Varices with Red Color Sign on Endoscopy: A Retrospective Analysis from the Natural Course
Kazunori Nagashima, Atsushi Irisawa, Ken Kashima, Fumi Sakuma, Takahito Minaguchi, Akira Yamamiya, Akane Yamabe, Koki Hoshi, Keiichi Tominaga, Makoto Iijima, Kenichi Goda
PMID: 35885720 DOI: 10.3390/healthcare10071193
Red color sign-positive (RC-positive) esophageal varices present a high bleeding risk, necessitating prophylactic treatment. Among RC-positive esophageal varices, those classified morphologically as small straight varices (Form level 1: F1) are difficult to treat. Moreover, the appropriate time for therapeutic intervention remains undefined. This study assessed the bleeding risk in RC-positive F1 esophageal varices. After extracting 541 cases of F1 esophageal varices diagnosed during 1 January 2012-29 February 2020, 76 cases of RC-positive F1 esophageal varices were divided into two groups in terms of treatment intervention at diagnosis: 49 cases with (treatment group) and 27 cases without (follow-up group). We assessed the bleeding rates, bleeding-associated factors, and early-bleeding-associated factors. The treatment group’s bleeding rate was 10% (5/49). The follow-up group’s bleeding rate was 78% (21/24). The subsequent bleeding rate was low in the treatment group (p < 0.001). The median period of sustained absence of bleeding was longer in the treatment group than in the follow-up group (1156 [274-1582] days vs. 105 [1-336] days; p < 0.001). In the follow-up group, a significant number of bleedings had varices that included a hematocystic spot (HCS) as RC or combined with RC (p = 0.017). Early bleeding occurred often in varices that included HCS or combined with RC (p = 0.024). Red wale marking (RWM) only was not a factor of early bleeding (p = 0.012). In conclusion, RC-positive varices should be treated even as F1 varices. Patients with RWM only show the possibility of not accepting early treatment intervention. A fast response is crucially important in HCS cases because of its associated bleeding and early bleeding.
Keywords: endoscopic injection sclerotherapy; endoscopic variceal ligation; esophageal varices; red color sign; small straight varices.