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Yokoyama S, Ishizu Y, Honda T, Imai N, Ito T, Yamamoto K, Hinoki A, Sumida W, Shirota C, Tainaka T, Makita S, Yokota K, Uchida H, Ishigami M. Endoscopic injection sclerotherapy with polidocanol for cardiac varices in children and adolescents. Arch Pediatr 2023; 30:109-112. [PMID: 36509625 DOI: 10.1016/j.arcped.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/29/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Like esophageal varices, cardiac varices are often treated with endoscopic variceal ligation (EVL). However, we previously reported that EVL for cardiac varices may be associated with a high risk of rebleeding from the ulcer if the O-ring spontaneously drops off early. The efficacy and safety of para-variceal endoscopic injection sclerotherapy (EIS) with polidocanol for the treatment of cardiac varices in children and adolescents were evaluated. METHODS Eleven patients under 18 years of age with portal hypertension who underwent para-variceal EIS with polidocanol for cardiac varices with red signs, which were considered to be at high risk of bleeding, were retrospectively reviewed. RESULTS One session of para-variceal polidocanol-EIS was performed for each of the 11 patients. One patient experienced temporary hypoxia due to aspiration of saliva when the tracheal intubation tube was removed after the procedure but recovered by endotracheal suctioning; there were no other adverse events. In six of the eight cases in which efficacy could be evaluated, eradication of cardiac varices was achieved. CONCLUSION Para-variceal polidocanol-EIS may be considered instead of EVL for small cardiac varices with red signs in pediatric patients with cardiac varices.
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Affiliation(s)
- Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan.
| | - Takashi Honda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Norihiro Imai
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Takanori Ito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Kenta Yamamoto
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya-shi, Aichi 4668550, Japan
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Bektas M, Seven G, Idilman R, Yakut M, Doğanay B, Kabacam G, Ustun Y, Korkut E, Kalkan Ç, Sahin G, Cetinkaya H, Bozkaya H, Yurdaydin C, Bahar K, Cinar K, Soykan I. Manometric assessment of esophageal motor function in patients with primary biliary cirrhosis. Eur J Intern Med 2014; 25:230-4. [PMID: 24534163 DOI: 10.1016/j.ejim.2014.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 01/17/2023]
Abstract
INTRODUCTION/AIM Primary biliary cirrhosis is associated with other autoimmune diseases including Sjögren's syndrome, and scleroderma. Esophageal dysmotility is well known in scleroderma, and Sjögren's syndrome. The aim of this study is to investigate whether any esophageal motor dysfunction exists in patients with primary biliary cirrhosis. METHOD The study was performed in 37 patients (36 women, mean age: 56.29 ± 10.01 years) who met diagnostic criteria for primary biliary cirrhosis. Thirty-seven functional dyspepsia patients, were also included as a control group. Patients entering the study were asked to complete a symptom questionnaire. Distal esophageal contraction amplitude, and lower esophageal sphincter resting pressure were assessed. RESULTS Manometric findings in primary biliary cirrhosis patients vs. controls were as follows: Median lower esophageal sphincter resting pressure (mmHg): (24 vs 20, p=0.033); median esophageal contraction amplitude (mmHg): (71 vs 56, p=0.050); mean lower esophageal sphincter relaxation duration (sc, x ± SD): (6.10 ± 1.18 vs 8.29 ± 1.92, p<0.001); and median lower esophageal sphincter relaxation (%) (96 vs 98, p=0.019); respectively. No significant differences were evident in median peak velocity (sc) (3.20 vs 3.02, p=0.778) between patients with primary biliary cirrhosis and the functional dyspepsia patients. Esophageal dysmotility was found in 17 (45.9%) primary biliary cirrhosis patients (non-specific esophageal motor disorder in ten patients, hypomotility of esophagus in five patients, nutcracker esophagus in one patient and hypertensive lower esophageal sphincter in one patient). CONCLUSION Esophageal dysmotility was detected in 45.9% of patients. The study suggests that subclinic esophageal dysmotility is frequent in patients with primary biliary cirrhosis.
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Affiliation(s)
- Mehmet Bektas
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Gulseren Seven
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Ramazan Idilman
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Mustafa Yakut
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Beyza Doğanay
- Ankara University School of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Gökhan Kabacam
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Yusuf Ustun
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Esin Korkut
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Çağdaş Kalkan
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Günay Sahin
- Ankara University School of Medicine, Department of Immunology, Ankara, Turkey
| | - Hulya Cetinkaya
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Hakan Bozkaya
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Cihan Yurdaydin
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Kadir Bahar
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Kubilay Cinar
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - Irfan Soykan
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
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3
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van Beljon J, Krige JEJ, Bornman PC. Intramural esophageal hematoma after endoscopic injection sclerotherapy for bleeding varices. Dig Endosc 2004. [DOI: 10.1111/j.1443-1661.2004.00299.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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4
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Ghoshal UC, Dhar K, Chaudhuri S, Pal BB, Pal AK, Banerjee PK. Esophageal motility changes after endoscopic intravariceal sclerotherapy with absolute alcohol. Dis Esophagus 2000; 13:148-51. [PMID: 14601907 DOI: 10.1046/j.1442-2050.2000.00104.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endoscopic sclerotherapy (EST) leads to structural and motility changes in the esophagus; the former are thought to be commoner after EST with absolute alcohol (AA), which is a commonly used sclerosant in India as it is cheap and effective. There are no previous studies on changes in esophageal motility after EST with AA. Accordingly, we studied patients with portal hypertension before (n = 24) and after (n = 22) variceal obliteration by EST with AA using a water perfusion esophageal manometry system. Contraction amplitude in the distal esophagus was reduced in the post-EST group compared with the pre-EST group (63.4 +/- 24.9 vs. 18.2 +/- 14.3 mmHg, p < 0.01). Duration of esophageal contraction in both the proximal and distal esophagus became prolonged in the post-EST compared with the pre-EST group (3.3 +/- 0.8 vs. 5.4 +/- 2.6 and 4.3 +/- 1.1 vs. 6.6 +/- 2.3 s, p < 0.001 for both). Lower esophageal sphincter (LES) pressure was reduced in the post-EST compared with the pre-EST group, although the difference was not significant statistically. Abnormal contraction waveforms were more frequent in the post-EST group. One patient in the post-EST group had persistent dysphagia in the absence of endoscopically documented stricture at the time of manometric study. This study shows frequent occurrence of esophageal dysmotility after EST with AA; however, esophageal dysmotility after EST was infrequently associated with motor dysphagia.
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Affiliation(s)
- U C Ghoshal
- Department of Gastroenterology, Seth Sukhlal Karnani Memorial Hospital and Institute of Postgraduate Medical Education and Research, 244, Acharya JC Bose Road, Calcutta 700020, India.
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5
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Kupfer Y, Cappell MS, Tessler S. Acute gastrointestinal bleeding in the intensive care unit. The intensivist's perspective. Gastroenterol Clin North Am 2000; 29:275-307, v. [PMID: 10836184 DOI: 10.1016/s0889-8553(05)70117-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gastrointestinal (GI) hemorrhage is a common and potentially lethal medical emergency that is a common cause for intensive care unit admission. The intensivist plays an important role as a member of the medical team managing the patient with GI bleeding who is at high risk because of severe bleeding, comorbidity, or the presence of endoscopic stigmata of recent hemorrhage. This article presents the intensivist's approach to GI hemorrhage in initial patient assessment, triage, resuscitation, specialist consultation, diagnostic evaluation, and medical therapy. This article focuses on types of GI bleeding of particular concern to the intensivist, including esophageal variceal bleeding, stress-related GI bleeding, and GI bleeding associated with myocardial infarcation.
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Affiliation(s)
- Y Kupfer
- Division of Pulmonary and Critical Care Medicine, Maimonides Medical Center, Brooklyn, New York, USA
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6
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Cappell MS, Abdullah M. Management of gastrointestinal bleeding induced by gastrointestinal endoscopy. Gastroenterol Clin North Am 2000; 29:125-67, vi-vii. [PMID: 10752020 DOI: 10.1016/s0889-8553(05)70110-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Therapeutic gastrointestinal endoscopy has a much greater risk of inducing gastrointestinal hemorrhage than diagnostic endoscopy. For example, colonoscopic polypectomy has a risk of approximately 1.6% of inducing bleeding, compared with a risk of approximately 0.02% for diagnostic colonoscopy. Higher-risk procedures include colonoscopic polypectomy, endoscopic biliary sphincterotomy, endoscopic dilatation, endoscopic variceal therapy, percutaneous endoscopic gastrostomy, and endoscopic sharp foreign body retrieval. The risk of inducing hemorrhage is decreased by meticulous endoscopic technique. Hemorrhage from endoscopy may be immediate or delayed. Immediate hemorrhage should be immediately treated by endoscopic hemostatic therapy, including injection therapy, thermocoagulation, or electrocoagulation. Delayed hemorrhage generally requires repeat endoscopy for diagnosis and for therapy, using the same hemostatic techniques.
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Affiliation(s)
- M S Cappell
- Division of Gastroenterology, Maimonides Medical Center, Brooklyn, New York, USA
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7
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Ghoshal UC, Saraswat VA, Aggarwal R, Misra A, Dhiman RK, Naik SR. Oesophageal motility and gastro-oesophageal reflux: effect of variceal eradication by endoscopic sclerotherapy. J Gastroenterol Hepatol 1998; 13:1033-8. [PMID: 9835320 DOI: 10.1111/j.1440-1746.1998.tb00566.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endoscopic injection sclerotherapy (EIS) is known to produce oesophageal structural and motility changes; however, alterations in frequency and severity of gastro-oesophageal reflux (GER) following EIS have not been investigated in detail. We studied 22 patients with cirrhosis and oesophageal varices before EIS and 26 after variceal eradication with intravariceal EIS using manometry and 24 h pH monitoring. The post-EIS group had reduced oesophageal sphincter pressure (19.2+/-11.4 vs 26.1 +/-16.4 mmHg, P< 0.05) and slower velocity of oesophageal peristalsis (2.47+/-0.71 vs 3.06+/-0.77 cm/s, P< 0.01) than the pre-EIS patients. There was no difference in the amplitude or duration of the contraction. Abnormal contraction wave-forms were observed more frequently in post-EIS than in the pre-EIS patients (3/22 vs 12/26, P< 0.05). Various quantitative parameters for GER were not increased in post-EIS compared with pre-EIS patients. Abnormal GER was present in nine of 21 pre-EIS and eight of 17 post-EIS patients (no significant difference). These results suggest that although persistent oesophageal motility changes are frequent after intravariceal EIS, these do not lead to a significant increase in GER.
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Affiliation(s)
- U C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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8
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Tio TL, Kimmings N, Rauws E, Jansen P, Tytgat G. Endosonography of gastroesophageal varices: evaluation and follow-up of 76 cases. Gastrointest Endosc 1995; 42:145-50. [PMID: 7590050 DOI: 10.1016/s0016-5107(95)70071-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endosonography was performed in 76 patients who had endoscopically detected gastroesophageal varices or questionable submucosal lesions, or who were being evaluated for pancreatic carcinoma or pancreatitis. The result were compared with surgery or autopsy results. The patients were divided retrospectively into four groups. Group 1 consisted of 6 patients who underwent surgery or autopsy. Five esophageal varices and 1 fundic varix were diagnosed with endosonography and confirmed histologically. Group 2 consisted of 29 patients undergoing sclerotherapy. Intramural thickening of the esophagus and extramural collaterals were found in 20 of 22 patients, respectively. Endoscopy revealed fibrosis in 10 patients. Group 3 consisted of 16 patients evaluated for pancreatic disease. Fifteen fundic varices, 6 cardiac varices, and 5 extramural collateral veins were found by EUS. Group 4 consisted of 16 patients with questionable submucosal lesions and 9 patients with lesions recognized endoscopically as varices. EUS found varices in all 25 patients. In conclusion, EUS is an important procedure in the diagnosis and follow-up of gastroesophageal varices, and in the identification of questionable abnormalities found endoscopically. The effect of sclerotherapy can be demonstrated as mural thickening with disappearance of submucosal varices.
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Affiliation(s)
- T L Tio
- Georgetown University Medical Center, Division of Gastroenterology, Washington, D.C. 20007-2197, USA
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9
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Ink O, Martin T, Poynard T, Reville M, Anciaux ML, Lenoir C, Marill JL, Labadie H, Masliah C, Perrin D. Does elective sclerotherapy improve the efficacy of long-term propranolol for prevention of recurrent bleeding in patients with severe cirrhosis? A prospective multicenter, randomized trial. Hepatology 1992; 16:912-9. [PMID: 1398497 DOI: 10.1002/hep.1840160410] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We conducted a prospective, multicenter, randomized trial to compare the efficacy of sclerotherapy plus propranolol with that of propranolol alone in the prevention of recurrent gastroesophageal bleeding in severely cirrhotic patients. For 2 yr (1987 to 1988) 131 patients (96% of whom were alcoholic) with Child-Pugh class B or C cirrhosis (56% were class B and 44% were class C) were randomly assigned to one of our two treatment groups after cessation of variceal bleeding, without hemostatic sclerosis, and were observed for at least 2 yr. Treatment observance was good in 89% of cases; alcohol withdrawal was observed in 62% of cases. Sclerotherapy was performed weekly with 1% polidocanol, and variceal obliteration was obtained in 83% of cases, in a mean number of four sessions. The cumulative percentages (expressed as mean +/- S.D.) of recurrent bleeding at 2 yr were 42% +/- 6% for propranolol plus sclerotherapy and 59% +/- 6% for propranolol alone (a nonsignificant difference). Twenty-eight patients from the propranolol group but only 12 patients from the propranolol-plus-sclerotherapy group had recurrent bleeding from esophageal variceal rupture (p less than 0.01). The total number of blood units per patient with recurrent bleeding was slightly but not significantly more important in the propranolol group (8 +/- 7) than in the propranolol-plus-sclerotherapy group (5 +/- 5; p = 0.09).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- O Ink
- Service des Maladies du Foie et de l'Appareil Digestif, Hôpital Bicêtre, Le Kremlin Bicêtre, France
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10
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Donahue PE, Sugitani A, Carvalho P. Endoscopic control of gastro-esophageal reflux: status report. World J Surg 1992; 16:343-6. [PMID: 1561822 DOI: 10.1007/bf02071545] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gastro-esophageal reflux disease is a common disorder which sometimes requires surgical treatment. Until recently, surgical treatment was the only alternative for severe complications of reflux. During the past 5 years endoscopic treatments for reflux have been reported from several medical centers. These new approaches may herald a new era for the treatment of reflux complications. However, at this time they are purely experimental approaches. Since physiologic antireflux mechanisms involve the muscles of the proximal gastric cardia as well as those of the lower esophageal sphincter, it is not surprising that endoscopic treatments have been directed at these two areas. However, the first endoscopic attempts at reflux control were directed at the lower esophagus sphincter. The most recent efforts at endoscopic control have been aimed at the proximal stomach, based on the concept that scarification beneath the lower end of the esophagus reduces the amount or frequency of reflux. Neither of these latter approaches has been reported in human patients. Since all endoscopic approaches are potentially dangerous, we recommend the adoption of a rigorous protocol for all human application. A possible protocol for this purpose is described herein; the authors will provide data analysis for any cohort of patients receiving endoscopic therapy, and will provide the results of all endoscopic treatments to any serious investigators.
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Affiliation(s)
- P E Donahue
- Department of Surgery, University of Illinois, Chicago
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11
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Paquet KJ, Koussouris P, Keinath R, Rambach W, Kalk JF. A comparison of sucralfate with placebo in the treatment of esophageal ulcers following therapeutic endoscopic sclerotherapy of esophageal varices--a prospective controlled randomized trial. Am J Med 1991; 91:147S-150S. [PMID: 1882901 DOI: 10.1016/0002-9343(91)90467-c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In 1984 Roark published the first report of a sucralfate treatment of esophageal ulcers after sclerotherapy. Because this was an uncontrolled trial we planned a prospective double-blind placebo-controlled study with 60 patients. After therapeutic paravariceal injection-sclerotherapy of esophageal varices, patients were randomly treated with sucralfate suspension or placebo. Time of treatment was limited to a maximum of 3 weeks and the dosage of sucralfate was 1 g q.i.d. (Ulcogant-Suspension). Healing was assessed by endoscopy at weekly intervals. Fifty-three patients (25 sucralfate, 28 placebo) were evaluable according to the protocol. No patient left the study because of side effects. At the start of the trial, the patients in the sucralfate group showed a larger ulcer area than the placebo group. There was a tendency to faster healing in the sucralfate group, especially in patients with deeper ulcerations. However, there was no significant difference in global healing between both treatment groups after 3 weeks. Sucralfate suspension may be of value in accelerating the healing process in esophageal ulcers after sclerotherapy, especially in patients with deep ulcers. These results should be confirmed in further trials, in which patients should be stratified with respect to their ulcer volume and severity of liver disease.
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Affiliation(s)
- K J Paquet
- Department of Surgery and Medicine, Heinz-Kalk Hospital, Bad Kissingen, Germany
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12
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Sauerbruch T, Fischer G, Ansari H. Variceal injection sclerotherapy. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1991; 5:131-53. [PMID: 1854983 DOI: 10.1016/0950-3528(91)90009-p] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With the development and widespread use of flexible endoscopes, injection sclerotherapy of oesophageal varices has advanced beyond the early stages. Although slightly different techniques and different sclerosants are used, the results are not strikingly different. The cumulative rate of adverse effects is in the range of 20 to 40%, with a procedure-related mortality of around 1 to 2%. Sclerotherapy is the best available treatment for haemostasis of acute oesophageal variceal bleeding. However, as a long-term therapy it is less effective in the prevention of recurrent gastrointestinal bleeding events, since obliteration of all varices often takes several months. Furthermore, extra-oesophageal bleeding is not amenable to sclerotherapy. Thus, if repeated injections fail to prevent recurrent bleeding, other options such as shunt surgery, transection, chronic medical portal decompression with beta-blockers or even liver transplantation should be considered according to the needs of the individual patient. Prophylaxis of first variceal haemorrhage was beneficial in selected patients with a high bleeding risk. It cannot, however, be generally recommended at present.
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13
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Andreani T, Poupon RE, Balkau BJ, Trinchet JC, Grange JD, Peigney N, Beaugrand M, Poupon R. Preventive therapy of first gastrointestinal bleeding in patients with cirrhosis: results of a controlled trial comparing propranolol, endoscopic sclerotherapy and placebo. Hepatology 1990; 12:1413-9. [PMID: 2258157 DOI: 10.1002/hep.1840120624] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Propranolol and endoscopic sclerosis of esophageal varices are the two approaches currently used in prophylaxis of the first gastrointestinal hemorrhage in the cirrhotic patient. One hundred twenty-six cirrhotic patients with esophageal varices and no histories of bleeding were included in the trial regardless of the gravity of the cirrhosis or the size of the esophageal varices. Patients with hepatocarcinomas or other cancers, clearly impossible follow-up, previous treatment for portal hypertension or contraindication to beta-blockers were excluded. After randomization, 43 patients received propranolol twice daily at a dose reducing the heart rate by 25%; 42 patients were treated with intravariceal and extravariceal injections of Polidocanol; 41 control patients received vitamin K orally as placebo. The patients were seen at 3-mo intervals for 2 yr. On entry to the trial the three groups were comparable in terms of clinical and biological parameters, including size of esophageal varices (grade I = 51, grade II = 54, grade III = 17), Child-Pugh classification (A = 29, B = 61, C = 32) and the origin of cirrhosis (alcoholic in 79% of cases). Twenty-four patients bled (two bled in the propranolol group, nine bled in the endoscopic sclerosis of esophageal varices group and 13 bled in the placebo group). Actuarial estimates (Kaplan-Meier) of the time of onset of first bleeding showed that the differences were significant between propranolol and placebo (p less than 0.004) and between propranolol and sclerotherapy (p less than 0.03) but not between sclerotherapy and placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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14
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Donahue PE, Carvalho PJ, Davis PE, Shen YJ, Miidla I, Bombeck CT, Nyhus LM. Endoscopic sclerosis of the gastric cardia for prevention of experimental gastroesophageal reflux. Gastrointest Endosc 1990; 36:253-6. [PMID: 2365211 DOI: 10.1016/s0016-5107(90)71017-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Surgical anti-reflux therapy appears to involve the muscles of the proximal gastric cardia and those of the lower esophageal sphincter. In an experimental canine reflux model, we injected sclerosant solution into the submucosa of the proximal gastric cardia, hypothesizing that the subsequent fibrotic reaction might exert an anti-reflux effect. Reflux was induced by atropine infusion, and the amount of reflux was quantitated by pH monitoring. Endoscopic sclerosis was effective in preventing reflux induced by high-dose atropine. Because the length and pressure of the lower esophageal sphincter were unaffected by endoscopic treatment, reflux prevention was possibly related to enhancement of the gastric component of the reflux barrier.
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Affiliation(s)
- P E Donahue
- Department of Surgery, University of Illinois, Chicago
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Kochhar R, Goenka MK, Mehta S, Mehta SK. A comparative evaluation of sclerosants for esophageal varices: a prospective randomized controlled study. Gastrointest Endosc 1990; 36:127-30. [PMID: 2185977 DOI: 10.1016/s0016-5107(90)70965-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The aim of this prospective randomized controlled study was to find a safe and effective sclerosing solution for endoscopic injection sclerotherapy in the treatment of esophageal variceal bleeding. Ninety consecutive patients with portal hypertension and variceal bleeding were randomized to receive sclerotherapy with 5% ethanolamine oleate, 3% sodium tetradecyl sulfate, or absolute alcohol at an interval of 3 weeks. Sixty-four patients who received more than three sessions were analyzed. All three agents were found to have similar success and complication rates (p greater than 0.05). However, absolute alcohol required fewer sessions (p less than 0.01) and lesser amounts (p less than 0.01) to produce successful variceal sclerosis and had the added advantage of low cost and easy availability.
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Affiliation(s)
- R Kochhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Tabibian N, Smith JL, Graham DY. Sclerotherapy-associated esophageal ulcers: lessons from a double-blind, randomized comparison of sucralfate suspension versus placebo. Gastrointest Endosc 1989; 35:312-5. [PMID: 2670659 DOI: 10.1016/s0016-5107(89)72799-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We undertook a double-blind randomized trial to assess whether sucralfate suspension would accelerate healing of sclerotherapy-associated esophageal ulcers. Consecutive patients who underwent sclerotherapy were evaluated. Patients were prospectively endoscoped 4 days (range, 3 to 5 days) after sclerotherapy. Those with ulcers greater than 5 mm in diameter were randomized to receive sucralfate suspension, 4 g/day (10 ml four times a day), or placebo. Endoscopic evaluations were done weekly for the 4 weeks of therapy. Nineteen patients survived long enough to be evaluated; complete ulcer healing was scored as success. Nine patients (13 ulcers) received sucralfate and 10 patients (17 ulcers) received placebo. At the end of 4 weeks, 78% of ulcers in sucralfate-treated patients had healed compared with 40% in the placebo group (p = not significant). Large ulcers were found to heal more slowly (p = 0.03, life table analysis) and small ulcers were disproportionally represented in patients receiving sucralfate (67% compared with 40% in the placebo group). When ulcer size was taken into account, the possible drug advantage disappeared; ulcer size appears to be a major determinant of rate of healing of sclerotherapy-associated esophageal ulcers. A large multicenter trial will be required to identify whether sucralfate accelerates postsclerotherapy esophageal ulcer healing.
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Affiliation(s)
- N Tabibian
- Digestive Disease Section, Veterans Administration Medical Center, Houston, Texas 77030
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17
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Sarin SK. Endoscopic sclerotherapy for esophago-gastric varices: a critical reappraisal. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1989; 19:162-71. [PMID: 2669716 DOI: 10.1111/j.1445-5994.1989.tb00234.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Amongst the many non-surgical techniques for the treatment of variceal bleeding, endoscopic sclerotherapy (EST) has shown great promise. EST can successfully obliterate esophageal varices and prevent variceal rebleeding. It is also very effective in the control of active bleeding from esophageal varices. The technique of EST is simple and can be carried out with a conventional, forward viewing, flexible endoscope and a teflon injector. Weekly intravariceal injections of an aqueous sclerosant are preferable. Though complications of EST in experienced hands are low, prophylactic EST at present should be advocated only to patients at high risk of bleeding. While controversy exists, most reports indicate that EST improves survival of patients with portal hypertension who have bled from esophageal varices. With regular follow-up endoscopies, recurrence of varices and bleeding from them can be substantially reduced. Sclerotherapy may successfully obliterate gastric varices in some patients either following EST for esophageal varices or by direct gastric variceal injections. For the long-term management of portal hypertension, combination of pharmacotherapy before as well as after eradication of esophageal varices, needs proper evaluation.
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Affiliation(s)
- S K Sarin
- Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India
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18
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Wu KL, Chou PD, Huang CM, Tang HS, Chen CF, Cheng TC. A clinical controlled trial of endoscopic sclerotherapy for repeated esophageal variceal bleeding. GASTROENTEROLOGIA JAPONICA 1989; 24:70-4. [PMID: 2540056 DOI: 10.1007/bf02774874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Thirty-seven patients with postnecrotic cirrhosis of the liver and 13 patients with primary hepatoma were proven to have repeated bleeding from ruptured esophageal varices. Clinically controlled trials were performed by assigning patients to either sclerotherapy or control arms (25 patients each). Combined intra-variceal and para-variceal injection before an upper endoscopic examination was performed in the sclerotherapy group. In all 25 sclerotherapy cases (100%) hemostasis was successful, which was a statistically significant success rate compared to the control group (52.0%) (p less than 0.01). In the sclerotherapy group 20% (5/25 cases) developed rebleeding, which was less than the 48.0% (7 cases of continuous bleeding and 5 cases of rebleeding) of the control group (p less than 0.05). Four cases (16.0%) in the sclerotherapy group died of erosive gastritis with massive bleeding, compared to 8 fatalities (32.0%) in the control group, because of uncontrolled esophageal variceal bleeding. Endoscopic sclerotherapy is a very effective method for arresting bleeding esophageal varices, and for decreasing the rebleeding rate.
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Affiliation(s)
- K L Wu
- Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan
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19
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Donahue PE, Carvalho P, Yoshida J, Miidla I, Shen YJ, Bombeck CT, Nyhus LM. Endoscopic sclerosis of the cardia affects gastroesophageal reflux. Surg Endosc 1989; 3:11-2. [PMID: 2711302 DOI: 10.1007/bf00591308] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Gastroesophageal reflux disease remains a disorder of unknown etiology associated with abnormal function of the lower esophageal sphincter (LES) and other physiological co-factors of the pathologic reflux. Effective operations for reflux are designed to reinforce the anti-reflux barrier and alter the tendency towards abnormal reflux. We have postulated that the most important component of these procedures is the prevention of distraction of the lowermost components of the LES at the onset of a potential reflux episode. Distraction of the LES causes shortening of the effective sphincter mechanism and can initiate experimental reflux events. In this study we used endoscopic sclerosis of the submucosal space at the cardia as a means of reducing distraction of the cardia in the hope that this would reduce abnormal reflux events. Canine gastroesophageal reflux was induced by intravenous atropine and monitored by continuous esophageal pH monitoring. Sclerosis of the cardia prevented gastroesophageal reflux, without measurable effect on the LES pressure or length. Endoscopic sclerosis of the cardia may be a useful technique in the control of human gastroesophageal reflux.
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Affiliation(s)
- P E Donahue
- Department of Surgery, Cook County Hospital, Chicago, Illinois 60612
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20
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Pascu O. Which endoscopic sclerotherapy technique is preferable to control and then prevent variceal hemorrhage? Gastrointest Endosc 1988; 34:483-4. [PMID: 3266161 DOI: 10.1016/s0016-5107(88)71444-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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21
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Piai G, Cipolletta L, Claar M, Marone G, Bianco MA, Forte G, Iodice G, Mattera D, Minieri M, Rocco P. Prophylactic sclerotherapy of high-risk esophageal varices: results of a multicentric prospective controlled trial. Hepatology 1988; 8:1495-500. [PMID: 3056821 DOI: 10.1002/hep.1840080605] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In this prospective, multicenter trial, 140 cirrhotic patients with no previous upper gastrointestinal bleeding and with esophageal varices endoscopically judged to be at high risk of hemorrhage were randomized to receive either sclerotherapy or conservative treatment for the prevention of first variceal bleeding. The end-points of the study were bleeding and death. Life table curves showed that prophylactic sclerotherapy significantly diminished the incidence of variceal hemorrhage (p less than 0.001) and overall mortality (p less than 0.01). Two-year cumulative bleeding rate was 18% in the sclerosis group (95% confidence interval = 10 and 31) and 57% (95% confidence interval = 40 and 72) in the control group. Two-year cumulative mortality rate was 30% (95% confidence interval = 19 and 45) in the sclerotherapy group and 56% (95% confidence interval = 39 and 72) in the controls. One patient died after hemorrhage from an ulcer secondary to sclerotherapy. Analysis by the Cox model of the factors potentially confounding or interacting with the effect of sclerotherapy suggested that sclerotherapy was more efficient in preventing first bleeding in patients with decompensated disease (Child B and C) than in those in good condition (Child A). However, the 2-year cumulative bleeding rate of untreated Child A patients was only 19%, showing how in this group the endoscopic findings were unreliable in selecting high-risk varices and explaining why after a 2-year follow-up prophylactic sclerosis did not show any benefit in such patients. We conclude that sclerotherapy can decrease the incidence of first variceal bleeding and death for a period of 2 years in cirrhotic patients with high-risk varices.
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Affiliation(s)
- G Piai
- Division of Gastroenterology, Second Medical Faculty, University of Naples, Italy
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22
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Bovero E, Farese A. Manometric evaluation of esophageal motility in patients submitted to prophylactic variceal sclerosis. Surg Endosc 1988; 2:156-8. [PMID: 3238549 DOI: 10.1007/bf02498790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Sclerotherapy of esophageal varices is an effective hemostatic treatment and may also prevent bleeding. In our study, we examined the effects of prophylactic sclerotherapy on esophageal motility in 15 patients with Child's A cirrhosis of the liver. All the patients underwent three manometric measurements, performed respectively before the sclerotherapy, 1 week after the eradication of varices, and 3 months later. The results of our study show that prophylactic sclerotherapy of esophageal varices does not significantly change the resting pressure and length of the lower esophageal sphincter. Neither the amplitude nor the duration of the postswallowing esophageal peristaltic waves is significantly influenced by sclerotherapy. However, sclerotherapy produces a significant increase in tertiary contractions in the distal esophagus, which could explain the onset of dysphagia among patients in whom postsclerotherapy stricture is not evident.
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Affiliation(s)
- E Bovero
- Department of Gastroenterology, Ospedale S. Martino, Genova, Italy
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23
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Wienbeck M, Berges W, Lübke HJ. Drug-induced oesophageal lesions. BAILLIERE'S CLINICAL GASTROENTEROLOGY 1988; 2:263-74. [PMID: 3044462 DOI: 10.1016/0950-3528(88)90003-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Persisting retrosternal pain of sudden onset is suggestive of a drug-induced oesophageal lesion, particularly if it starts at night. After exclusion of a myocardial infarction, a carefully taken history and oesophagoscopy will rapidly clarify the cause and severity of the injury. Since almost any pill may produce oesophageal lesions, care has to be taken that tablets, capsules and other pills are always taken in an upright position together with a fluid chaser of at least 120 ml. If possible, less harmful liquid preparations of the drugs should be preferred. Lesions in the oesophageal wall and perioesophageal tissue are almost unavoidable side-effects of sclerotherapy of oesophageal varices. The patient and the doctor should be particularly aware of bleeding from oesophageal ulcers during the first week after sclerotherapy. Numerous drugs may weaken or strengthen contractions of the oesophagus and lower oesophageal sphincter. These potentially unwanted motor effects of the drugs have to be kept in mind, especially in patients with pre-existing gastro-oesophageal reflux disease and hypermotility states.
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24
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Magnano A, Passanisi G, Longo C, Rizzo L, Belluardo N, Russo A. Early and late complications of endoscopic oesophageal varices sclerotherapy. Surg Endosc 1988; 2:209-12. [PMID: 3266535 DOI: 10.1007/bf00705322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report the complications of perendoscopic sclerotherapy observed during treatment of oesophageal varices in 104 patients and 409 sclerotherapy sessions. Complications were related to each individual session and to the aim of the treatment (therapeutic or prophylactic). Major complications occurred in 17.3% of the patients treated: 13 cases of severe bleeding and 5 of oesophageal stricture. Conservative therapy stopped haemorrhage in all but 4 patients, who died of uncontrolled bleeding (3.8%). Three oesophageal strictures recovered spontaneously, while the remaining two required endoscopic dilations. Minor complications occurred after 102/409 sessions (24.9%). Epigastric and/or retrosternal pain developed after 17.6% of the sessions, oesophageal ulcerations after 12.5%, fever after 11.7% and transient dysphagia after 3.7%. Bleeding was observed only in Child's category C patients who underwent therapeutic treatment. The risk of bleeding remained unchanged until complete eradication of varices was achieved. The incidence of minor complications did not correlate with the progression or the aim of the treatment.
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Affiliation(s)
- A Magnano
- Department of Surgical Endoscopy, University of Catania, Italy
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25
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Morsiani E, Rimondi AP, Gorini P, Fogli L, Cappellari L, Gullini S. Effect of intravenous and intraperivenous injections of sclerosants (sodium tetradecyl sulfate and hydroxy polyethoxy dodecan) on the rat femoral vein. RESEARCH IN EXPERIMENTAL MEDICINE. ZEITSCHRIFT FUR DIE GESAMTE EXPERIMENTELLE MEDIZIN EINSCHLIESSLICH EXPERIMENTELLER CHIRURGIE 1987; 187:439-49. [PMID: 3441685 DOI: 10.1007/bf01852182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The sclerosant effect of injected tetradecyl sulfate of sodium (STS) and hydroxy polyethoxy dodecan (HPD) was studied in the rat femoral vein. Intravenous (i.v.) and intravenous plus perivenous (i.v. + p.v.) injections of both sclerosants and physiologic saline were compared as to vein lumen occlusion, fibrosis, phlogosis, and damage to the artery and surrounding nervous and muscular tissues. The study was carried out in 30 rats treated by STS, in 30 treated by HPD, and 15 animals were injected with saline. The neurovascular bundle and adjacent muscle were removed at 48 h, 7 and 30 days and examined histologically. I.v. injections of STS produced a solid occlusion of the vein in a significant number of cases, after 30 days (P less than 0.01). A statistically significant number of solid occlusions of the femoral vein resulted after i.v. + p.v. injection of STS and HPD, at 48 h, 7 and 30 days (P less than 0.05; P less than 0.01). There was no significant difference between STS and HPD after i.v. + p.v. injection. After i.v. + p.v. we recorded a marked inflammation of muscle with signs of focal necrosis, at 48 h and 7 days. Our study indicated that i.v. + p.v. injection of STS and HPD provided a high degree of efficacy as regards vein occlusion. On the other hand, i.v. + p.v. injection induced a severe inflammation and necrosis of the tissues surrounding the sclerosed vein. Extrapolating our results to the endoscopic sclerotherapy for esophageal variceal bleeding, we conclude that paravariceal injection of sclerosants is a dangerous procedure, even though efficacious to reduce variceal hemorrhage, owing to the high risk of iatrogenic ulcers and esophageal perforation caused by muscular and mucosal necrosis.
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Affiliation(s)
- E Morsiani
- Istituto di Patologia Chirurgica dell'Università di Ferrara, Italy
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26
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Kitano S, Iwanaga T, Iso Y, Koyanagi N, Sugimachi K. A transparent over-tube for endoscopic injection sclerotherapy and results in patients with esophageal varices. THE JAPANESE JOURNAL OF SURGERY 1987; 17:256-62. [PMID: 3682434 DOI: 10.1007/bf02470697] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This report describes our data regarding repeated injection sclerotherapy using a newly designed over-tube. We treated 17 consecutive patients with esophageal varices, (3 acute, 6 elective and 8 prophylactic). An intravariceal injection of 5 per cent ethanolamine oleate was administered, using a newly designed transparent over-tube containing a second lumen for a flexible injection needle. This over-tube provides an easier, safer, shorter-in-time method of sclerosing esophageal varices. One of the 17 patients died as a result of liver failure associated with advanced cirrhosis and a concomitant hepatoma. Eradication of esophageal varices was attained in the remaining 16 patients, after an average of 5.0 injections over an average period of 5.8 weeks (range: 3-7 injections during 3-11 weeks). No complications, such as esophageal perforation or aspiration pneumonia were encountered. Recurrent variceal bleeding has not occurred during the 9 months follow-up.
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Affiliation(s)
- S Kitano
- Department of Surgery II, Kyushu University, Faculty of Medicine, Fukuoka, Japan
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27
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Sarin SK, Nanda R, Sachdev G, Chari S, Anand BS, Broor SL. Intravariceal versus paravariceal sclerotherapy: a prospective, controlled, randomised trial. Gut 1987; 28:657-62. [PMID: 3305185 PMCID: PMC1433032 DOI: 10.1136/gut.28.6.657] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Fifty four consecutive patients with oesophageal variceal bleeding were randomised to undergo intravariceal (28 patients) or paravariceal (26 patients) sclerotherapy, every three weeks. Intravariceal technique was found significantly (p less than 0.01) more effective in controlling active variceal bleeding than the paravariceal technique (91% v 18.7% respectively). The mean (+/- SD) time taken for variceal eradication by intravariceal sclerotherapy (15.4 +/- 5.3 weeks) was significantly (p less than 0.001) less than paravariceal (26.8 +/- 6.6 weeks) technique. The number of sclerotherapy sessions needed with intravariceal technique were also significantly less. Rebleeding was seen in 38.5% patients after para and 14.3% after intravariceal injections (NS). Except for retrosternal pain, which occurred more often (p less than 0.01) with paravariceal technique, there was no difference in the incidence of other complications or mortality between the two groups. Variceal recurrence was seen in seven patients (25%) in the intra and one (3.9%) patient in the paravariceal group (p less than 0.01) after a mean follow up of 29.4 +/- 9.1 weeks. Intravariceal sclerotherapy was superior to paravariceal in the control of active variceal bleeding and for total variceal obliteration, but was associated with a higher variceal recurrence.
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28
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Kang JH, Kambayashi J, Sakon M, Shiozaki H, Ogawa Y, Ohshiro T, Mori T. Mechanism of the haemostatic effect of ethanolamine oleate in the injection sclerotherapy for oesophageal varices. Br J Surg 1987; 74:50-3. [PMID: 3828735 DOI: 10.1002/bjs.1800740116] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Changes in coagulation and fibrinolysis were investigated in 20 patients with oesophageal varices, who underwent endoscopic injection sclerotherapy (EIS) with 5 per cent ethanolamine oleate (EO), by means of serial determination of plasma fibrinopeptide A (FPA) and fibrinopeptide B beta 15-42 (B beta 15-42). One hour after the completion of EIS, the value of FPA was significantly increased to 38.1 +/- 11.1 ng/ml (mean +/- s.e.m.) from a pre-EIS value of 7.1 +/- 1.4 ng/ml (P less than 0.01) and it gradually returned to normal range by 48 h after EIS. A very similar change was observed in the value of B beta 15-42 (P less than 0.01). These observations indicated that EIS provokes transient activation of coagulation and fibrinolysis. In vitro studies, however, revealed that EO inhibits fibrin clot formation because of the Ca2+-chelating ability of its constituent ethanolamine, although oleate or benzyl alcohol exhibited procoagulant activity in FPA formation in vitro. Nevertheless, an external application of EO or oleate over decapsulized kidney of rat resulted in a significant accumulation of 125I-labelled fibrin(ogen). From these results it was suggested that intravascular injection of EO, which exerts an inhibitory effect on coagulation in vitro, activates the local coagulation system. The activation may be accelerated by an acute inflammatory process provoked by oleate, which is supported by such clinical manifestations as mild fever, retrosternal pain leukocytosis and an increase in plasma fibrinogen level which was observed in all during the period.
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29
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Jensen LS, Dybdahl H, Juhl C, Nielsen TH. Endoscopic sclerotherapy of esophageal varices in an experimental animal model. A histomorphologic study. Scand J Gastroenterol 1986; 21:725-32. [PMID: 3749806 DOI: 10.3109/00365528609011108] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic sclerotherapy with Aethoxysclerol 2% was carried out in rabbits with esophageal varices. Nineteen animals were injected paravenously, and 17 were injected intravenously. The animals were killed between 1 h and 4 weeks after injection for histologic examination of the esophagus. None of the animals showed an acute total occlusive thrombosis of the large vessels, whereas edema and later fibrosis compressed the varices in the paravenously injected animals. After 4 weeks an almost complete repair with patent varices was observed in the intravenously treated group, whereas the varices in the paravenously injected group either had shrunk totally or were surrounded by a dense envelope of connective tissue. The study suggests that paravenous treatment of esophageal varices provides a higher degree of efficacy.
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30
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Prévention, diagnostic et traitement des complications de la sclerothérapie. ACTA ACUST UNITED AC 1986. [DOI: 10.1007/bf02966223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Rose JD, Roberts GM, Smith PM. The radiological appearances of the oesophagus after sclerotherapy for varices. Clin Radiol 1985; 36:355-8. [PMID: 4064523 DOI: 10.1016/s0009-9260(85)80299-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Fifteen patients, whose oesophageal varices had been obliterated by injection sclerotherapy, were examined by double-contrast barium swallow. In nine patients (60%) the oesophagram was abnormal and demonstrated sharp-edged, longitudinal tramline filling defects and an irregular, patchy nodularity with loss of the normal longitudinal folds. These appearances represent redundant epithelial folds, epithelial tags and healed ulcers produced by endoscopic sclerotherapy.
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32
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Söderlund C, Backman L, Erwald R, Forsgren L, Marions O, Wiechel KL. Sclerotherapy of esophageal varices: an endoscopic and portographic study. Hepatology 1984; 4:877-84. [PMID: 6332767 DOI: 10.1002/hep.1840040514] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A prospective series of 26 patients with portal hypertension and recent bleeding from esophageal varices was investigated with percutaneous transhepatic selective portography (PTP). PTP was performed immediately prior to and, in 23 patients, just after the initial endoscopic injection sclerotherapy (ST) session to study the acute effects of ST on the mediastinal portal-systemic collaterals. Late follow-up PTP was performed after a median of 8 months in 21 of 26 patients considered endoscopically to be free from esophageal varices after a median of 6 ST sessions. Five patients rebled from esophageal or gastric varices during the follow-up period of 15 months, but there were no fatalities due to variceal hemorrhage. In all patients, the initial PTP showed portal-systemic mediastinal collaterals. Immediately after ST, it was not possible to opacify esophageal varices at all (10 patients) or only partially (7 patients). Five patients died prior to late follow-up PTP. Endoscopic judgment of complete eradication of esophageal varices after repeated ST was in agreement with the late PTP results in 18 of 21 patients. In one patient, PTP showed residual esophageal varices subsequently confirmed by endoscopy. The results were uncertain in two patients for technical reasons. This study supports the opinion that submucosal esophageal varicose veins, as visualized by PTP, can be efficiently eradicated by serial ST, leaving the other mediastinal collaterals unaffected.
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