内視鏡的硬化療法の手技と治療成績における透明フードの有用性

Objective: Although the effectiveness of a transparent hood has been reported in various endoscopic procedures, there are only a few reports regarding the benefit of a transparent hood in endoscopic injection sclerotherapy(EIS). In the current study, we conducted a retrospective evaluation of the efficacy and long-term benefit of an oblique transparent hood on EIS. Methods: The transparent hood, manufactured by Olympus (MAJ295 or MAJ296), consisted of a reusable wide oblique distal attachment with rim. This hood was attached when the varix was fine (F0 or F1). In this retrospective study, a total of 201 patients were recruited, and 99 patients (designated as the "Hood Group") received this hood while 102 patients (designated as the "Conventional Group") did not. We compared the rate of intravariceal injection, enhanced supply vessels, variceal eradication, and recurrence between these two groups. Results: This transparent hood provided a better visual field, and there was no serious complication in any of the patients. Intravariceal injection rates in the Hood Group and Conventional Group were 73.9% (190/257) and 57.7% (146/253) respectively (p<0.01). The rates of enhanced supply vessels in the Hood Group and Conventional Group were 89.8% (89/99) and 72.5% (74/102) respectively (p<0.01). The rates of variceal eradication did not differ significantly. We also assessed the cumulative non-recurrence probability for up to 3000 days between the two groups. The Hood Group was statistically superior to the Conventional Group (p<0.01) Conclusion: The application of an oblique transparent hood method is safe and effective for intravariceal EIS. This hood contributes especially to reduction of the long-term recurrence probability.博士（医学）・乙第1365号・平成27年11月27

Liver Abscesses after Peritoneal Venous Shunt

A 70-year-old man was referred to our hospital for high-grade fever with chills. He has visited our hospital for alcoholic liver cirrhosis and diabetes mellitus for over 20 years. Nine months earlier, he had received a peritoneal venous shunt (Denver shunt®) because of refractory ascites. Laboratory examinations revealed elevated C-reactive protein and liver dysfunction. Ultrasonography and abdominal enhanced computed tomography showed multiple small abscesses in the right lobe of the liver. Blood culture test did not detect the pathogenic bacteria of liver abscesses. The patient was treated with antibiotics for more than 2 months and cured from the infection, but 3 months later, he developed high-grade fever again. He had a recurrence of multiple small liver abscesses involving both lobes of the liver. He was treated with antibiotics, and the abscesses disappeared within a month. After the antibiotic treatment, he had selective intestinal decontamination with kanamycin. He has had no recurrence of liver abscess for over a year. To our knowledge, this is the first report of liver abscess in a cirrhotic patient with Denver shunt. Clinicians should bear liver abscess in mind when treating patients with high-grade fever and liver dysfunction following Denver shunt implantation