Endoscopic Treatment of Esophageal Varices: Consolidation Method Following Ethanolamine Oleate-Aethoxysklerol Combination Therapy

  • Katsutoshi ObaraEmail author


To further reduce the rate of recurrence following the eradication of esophageal varices with endoscopic injection sclerotherapy using ethanolamine oleate (EO)-aethoxysklerol (AS) combination method, we introduced the consolidation method (mucosal fibrosis method using AS, laser, or argon plasma coagulation (APC)). The consolidation method for esophageal varices consists essentially of complete disappearance of esophageal varices using the EO-AS combination method followed by fibrosing of the lower esophagus with AS, laser, or APC. APC consolidation has been widely performed to date due to its usability and efficacy in further preventing variceal recurrence. Although the whole lower esophagus is treated including thrombotic varices and normal esophageal mucosa, this method can make fibrosis all round in the esophageal wall without esophageal stenosis. APC has also been used to prevent recurrence after endoscopic variceal ligation and is reported to be effective.


Esophageal varices Obara method (EO-AS combination method) APC consolidation method (mucosal fibrosis method using APC) EVL-AS combination method and APC consolidation method 


  1. 1.
    Obara K, Masaki M, Sakamoto H, Iwasaki K, Mitsuhashi H, Orikasa K, et al. Studies on prognosis of patients with esophageal and gastric varices treated with injection sclerotherapy using EO or EO-AS combination method. Gastroenterol Endosc. 1987;29:2232–6. [in Japanese with English abstract].Google Scholar
  2. 2.
    Obara K, Ohira H, Sakamoto H, Iwasaki K, Mitsuhashi M, Suzuki S, et al. A new method of sclerotherapy for esophagogastric varices: EO-AS combination method followed by mucosa-fibrosis with AS. Gastroenterol Endosc. 1981;31:2977–81. [In Japanese with English abstract].Google Scholar
  3. 3.
    Obara K, Kojima T, Irisawa A, Watanabe S, Kuwana T, Kogure A, et al. A new method of sclerotherapy for esophageal varices: EO-AS combination method followed by mucosa-fibrosing with laser. Gastroenterol Endosc. 1994;36:716–21. [In Japanese with English abstract].Google Scholar
  4. 4.
    Grund KE, Storek D, Farin G. Endoscopic argon plasma coagulation (APC): first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol. 1994;2:42–6.PubMedGoogle Scholar
  5. 5.
    Obara K, Toyonaga A, Kokubu S. Guidelines for the endoscopic treatment of esophagogastric varices. In: Society for Japanese Gastroenterological Endoscopy, editor. Guidelines for gastrointestinal endoscopy. 3rd ed. Tokyo: Igaku-Shoin; 2006. p. 215–34. [in Japanese].Google Scholar
  6. 6.
    The Liver Cancer Study Group of Japan. The general rules for the clinical and pathological study of primary liver cancer, second English edition. Tokyo: Kanehara & Co., Ltd.; 2003.Google Scholar
  7. 7.
    Irisawa A, Saito A, Obara K, Shibukawa G, Takagi T, Shishido H, et al. Endoscopic recurrence of esophageal varices is associated with the specific EUS abnormalities: severe periesophageal collateral veins and large perforating veins. Gastrointest Endosc. 2001;53:77–84.CrossRefGoogle Scholar
  8. 8.
    Obara K. Endoscopic EV treatment. Endoscopic treatment of esophagogastric varices. Tokyo: Narunia Inc.; 2016. p. 21–46.Google Scholar
  9. 9.
    Obara K. Endoscopic injection sclerotherapy followed by mucosal fibrosis. JJPH. 2002;8:128–35. [In Japanese].Google Scholar
  10. 10.
    Obara K, Kasukawa R. Endoscopic ultrasonography for evaluation of patients treated by endoscopic injection sclerotherapy. Endosc Digest. 1990;2:1395–403. [In Japanese with English abstract].Google Scholar
  11. 11.
    Kikuchi Y. Pathological change of esophageal wall after argon plasma coagulation therapy for esophageal varices. JJPH. 2003;9:73–7. [in Japanese].Google Scholar
  12. 12.
    Obara K. Esophagogastric varices: indication, treatment procedure and outcomes. J Jpn Soc Intern Med. 2003;92(1):58–65. [In Japanese].CrossRefGoogle Scholar
  13. 13.
    Tajiri T, Yoshida H, Obara K, Onji M, Kage M, Kitano S, et al. General rules for recording endoscopic findings of esophagogastric varices (2nd edition). Dig Endosc. 2010;22(1):1–9. Scholar
  14. 14.
    The Japan Society for Portal Hypertension. The general rules for study of portal hypertension. 3rd ed. Tokyo: Kanehara & Co., Ltd; 2013. p. 37–62. [in Japanese].Google Scholar
  15. 15.
    Deguchi H, Kato J, Maeda Y, Moribata K, Shingaki N, Niwa T, et al. Argon plasma coagulation is effective for prevention of recurrent esophageal varices after endoscopic injection sclerotherapy: single-center case-control study. Dig Endosc. 2016;28:42–9. Scholar
  16. 16.
    Matsui S, Kudo M, Nakaoka R, Shiomi M. Effect of mucosa-fibrosing therapy with argon plasma coagulation on esophageal varices. JJPH. 2003;8:180–4. [In Japanese with English abstract].Google Scholar
  17. 17.
    Harras F, Sheta S, Shehata M, Saadany S, Selim M, Mansour L. Endoscopic band ligation plus argon plasma coagulation versus scleroligation for eradication of esophageal varices. J Gastroenterol Hepatol. 2010;25:1058–65. Scholar

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Advanced Gastrointestinal EndoscopyFukushima Medical UniversityFukushimaJapan

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