Skip to main content

Endoscopic Treatment of Esophageal Varices: Kitano Method

  • Chapter
  • First Online:
Clinical Investigation of Portal Hypertension

Abstract

A technique of endoscopic injection sclerotherapy (EIS) for esophageal varices, which Kitano et al. reported in 1987, consists of the use of an over-tube, a sclerosant of 5% ethanolamine oleate, and 1-week intervals between injections, with the EIS repeated until complete elimination of the lower esophageal mucosa. The technique was validated by several randomized controlled trials (RCTs) that were conducted by a portal hypertension group in the Department of Surgery II, Kyushu University. The results of 2105 cases showed that the cumulative nonbleeding rate was 90% at 15 years. This EIS technique was also compared with surgical procedures through another RCT and was equivalent to the surgical procedures in terms of nonbleeding and survival rates. In addition, the technique was also compared to endoscopic variceal ligation (EVL), and EVL significantly decreased the adverse effects associated with EIS. Although the EIS technique is now only performed in a limited number of institutions, it is safe, long-lasting, and established, and the achievement of favorable results remains excellent even now.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Crafoord C, Frenckner P. New surgical treatment of varicose veins of the oesophagus. Acta Otolaryngol. 1939;27:422–9.

    Article  Google Scholar 

  2. Johmston GW, Rodgers HW. A review of 15 years’ experience in the use of sclerotherapy in the controls of acute haemorrhage from oesophageal varices. Br J Surg. 1973;33:797–800.

    Article  Google Scholar 

  3. Terblanche J, Northover JM, Bornman P, Kahn D, Silber W, Barbezat GO, et al. A prospective controlled trial of sclerotherapy in the long term management of patients after esophageal variceal bleeding. Surg Gynecol Obstet. 1979;148:323–33.

    CAS  PubMed  Google Scholar 

  4. Takase Y, Ozaki A, Oril K, Nagoshi K, Okamura T, Iwasaki Y. Injection sclerotherapy of esophageal varices for patients undergoing emergency and elective surgery. Surgery. 1982;92:474–9.

    CAS  PubMed  Google Scholar 

  5. Kitano S, Hashizume M, Yamaga H, Wada H, Sugimachi K. Endoscopic injection sclerotherapy: variants of sclerotherapy technique. J Gastroenterol Hepatol. 1989;4(Suppl 1):171–2.

    PubMed  Google Scholar 

  6. Kitano S, Sugimachi K. A rapid and relatively safer method of sclerosing esophageal varices utilizing a new transparent tube. Am J Surg. 1987;153:317–9.

    Article  CAS  Google Scholar 

  7. Kitano S, Koyanagi N, Iso Y, Higashi H, Sugimachi K. Prevention of recurrence of esophageal varices after endoscopic injection sclerotherapy with ethanolamine oleate. Hepatology. 1987;7:810–5.

    Article  CAS  Google Scholar 

  8. Kitano S, Koyanagi N, Iso Y, Iwanaga T, Higashi H, Sugimachi K. Prospective randomized trial comparing two injection techniques for sclerosing oesophageal varices: over-tube and free-hand. Br J Surg. 1987;74:603–6.

    Article  CAS  Google Scholar 

  9. Hashizume M, Kitano S, Koyanagi N, Tanoue K, Ohta M, Wada H, et al. Endoscopic injection sclerotherapy for 1,000 patients with esophageal varices: a nine-year prospective study. Hepatology. 1992;15:69–75.

    Article  CAS  Google Scholar 

  10. Tomikawa M, Hashizume M, Okita K, Kitano S, Ohta M, Higashi H, et al. Endoscopic injection sclerotherapy in the management of 2105 patients with esophageal varices. Surgery. 2002;131(Suppl 1):S171–5.

    Article  Google Scholar 

  11. Kitano S, Iso Y, Hashizume M, Yamaga H, Koyanagi N, Wada H, et al. Sclerotherapy vs. esophageal transection vs, distal splenorenal shunt for the clinical management of esophageal varices in patients with Child class A and B liver function: a prospective randomized trial. Hepatology. 1992;15:63–8.

    Article  CAS  Google Scholar 

  12. 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;22:1–9. https://doi.org/10.1111/j.1443-1661.

    Article  PubMed  Google Scholar 

  13. Iso Y, Kitano S, Iwanaga T, Koyanagi N, Sugimachi K. A prospective randomized study comparing the effects of large and small volumes of the sclerosant 5% ethanolamine oleate injected into esophageal varices. Endoscopy. 1988;20:285–8.

    Article  CAS  Google Scholar 

  14. Kitano S, Iso Y, Koyanagi N, Higashi H, Sugimachi K. Ethanolamine oleate is superior to polidocanol (aethoxysklerol) for endoscopic injection sclerotherapy of esophageal varices: a prospective randomized trial. Hepatogastroenterology. 1987;34:19–23.

    CAS  PubMed  Google Scholar 

  15. Kitano S, Iso Y, Yamaga H, Hashizume M, Higashi H, Sugimachi K. Trial of sclerosing agents in patients with oesophageal varices. Br J Surg. 1988;75:751–3.

    Article  CAS  Google Scholar 

  16. Kitano S, Wada H, Yamaga H, Hashizume M, Koyanagi N, Iwanaga T, et al. Comparative effects of 5% ethanolamine oleate versus 5% sodium morrhuate for sclerotherapy of oesophageal varices. J Gastroenterol Hepatol. 1991;6:476–80.

    Article  CAS  Google Scholar 

  17. Higashi H, Kitano S, Hashizume M, Yamaga H, Sugimachi K. A prospective randomized trial of schedules for sclerosing esophageal varices. 1- versus 2-week intervals. Hepatogastroenterology. 1989;36:337–40.

    CAS  PubMed  Google Scholar 

  18. Hashizume M, Kitano S, Yamaga H, Sugimachi K. Haptoglobin protect against renal damage from ethanolamine oleate sclerosant. Lancet. 1988;2:340–1.

    Article  CAS  Google Scholar 

  19. Miyoshi H, Ohshiba S, Matsumoto A, Takada K, Umegaki E, Hirata I. Haptoglobin prevents renal dysfunction associated with intravariceal infusion of ethanolamine oleate. Am J Gastroenterol. 1991;86:1638–41.

    CAS  PubMed  Google Scholar 

  20. Wada H, Hashizume M, Yamaga H, Kitano S, Sugimachi K. Hemodynamic and morphological changes in the dog kidney after injection of 5% ethanolamine oleate into the superior vena cava. Eur Surg Res. 1990;22:63–70.

    Article  CAS  Google Scholar 

  21. Ohta M, Hashizume M, Ueno K, Tanoue K, Sugimachi K. Albumin inhibits hemolysis of erythrocytes induced by ethanolamine oleate during endoscopic injection sclerotherapy. Hepatogastroenterology. 1993;40:65–8.

    CAS  PubMed  Google Scholar 

  22. Kishihara F, Ohta M, Hashizume M, Tomikawa M, Kawanaka H, Tanoue K, et al. Systemic effects of ethanolamine oleate in analbuminemic rats. Hepatogastroenterology. 1999;46:376–80.

    CAS  PubMed  Google Scholar 

  23. Stiegmann VG, Goff JS. Endoscopic esophageal varix ligation: preliminary clinical experience. Gastrointest Endosc. 1988;34:113–7.

    Article  Google Scholar 

  24. Laine L, Cook D. Endoscopic ligation compared with sclerotherapy for treatment of esophageal variceal bleeding. A meta-analysis. Ann Intern Med. 1995;123:280–7.

    Article  CAS  Google Scholar 

  25. Hashizume M, Ohta M, Ueno K, Tanoue K, Kitano S, Sugimachi K. Endoscopic ligation of esophageal varices compared with injection sclerotherapy: a prospective randomized trial. Gastrointest Endosc. 1993;39:123–6.

    Article  CAS  Google Scholar 

  26. Hashizume M, Ohta M, Kawanaka H, Kishihara F, Sugimachi K. Recurrence rate of oesophageal varices with endoscopic banding ligation followed by injection sclerotherapy. Lancet. 1994;344:1643.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Masayuki Ohta .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ohta, M., Inomata, M., Kitano, S. (2019). Endoscopic Treatment of Esophageal Varices: Kitano Method. In: Obara, K. (eds) Clinical Investigation of Portal Hypertension. Springer, Singapore. https://doi.org/10.1007/978-981-10-7425-7_22

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-7425-7_22

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-7424-0

  • Online ISBN: 978-981-10-7425-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics