ethamolin and Gastrointestinal-Hemorrhage

The purpose of this review is to describe the clinical factors related to balloon-occluded retrograde transvenous obliteration, including the preparation needed, the technique and challenges, and the outcomes.. Although the procedure can be performed when transjugular intrahepatic portosystemic shunt is contraindicated or when endoscopic management fails, balloon-occluded retrograde transvenous obliteration is successful as a first-line or second-line therapy. Gastric variceal rebleeding rates are low and serious complications are rare. Randomized controlled trials are required to evaluate the superiority of this procedure over other methods of treating gastric varices and to determine which sclerosant should be used. In the near future, this procedure may play a larger role in emergency care and in the management of nongastric varices.

Topics: Balloon Occlusion; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Oleic Acids; Polidocanol; Polyethylene Glycols; Radiography, Interventional; Recurrence; Sclerosing Solutions; Sodium Tetradecyl Sulfate; Stomach; Tomography, X-Ray Computed; Vinblastine

Endoscopic injection sclerotherapy and/or endoscopic variceal ligation are well accepted and established in the treatment of bleeding esophageal varices. Endoscopic treatment for bleeding gastric varices is behind in hemostatic rate by 5% ethanolamine oleate as sclerosant. However, since cyanoacrylate is employed as endoscopic injection sclerosant, hemostatic rate was greatly improved especially for the bleeding large gastric varices. In addition angiographic sclerotherapy (balloon occluded retrograde transvenous obliteration) is highly effective for large gastric fundal varices and no rebleeding is expected when successfully done. Endoscopic and angiographic sclerotherapy made great improvement in the treatment of esophagogastric varices.

Topics: Cyanoacrylates; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Histamine H2 Antagonists; Humans; Ligation; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Vasoconstrictor Agents; Vasopressins

We report two cases of squamous cell carcinoma of the esophagus following endoscopic injection sclerotherapy for esophageal varices. The interval between sclerotherapy and the development of carcinoma was 24 months in case 1 and 21 months in case 2. The sclerosant was 5% sodium morrhuate in case 1 (total dose, 10 ml) and 5% ethanolamine oleate in case 2 (45.5 ml). Although no recurrent variceal bleeding occurred after sclerotherapy, we could not perform any curative surgical treatment for esophageal cancer because of the advanced stage of the cancer and the severity of the accompanying liver dysfunction. It is difficult to determine the relationship between sclerotherapy and carcinoma; however, long-term surveillance is essential to avoid overlooking a neoplasm in the esophagus after endoscopic injection sclerotherapy.

Topics: Carcinoma, Squamous Cell; Esophageal and Gastric Varices; Esophageal Neoplasms; Esophagoscopy; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Sodium Morrhuate; Time Factors

Topics: Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Oleic Acids; Sclerosing Solutions

Sclerotherapy is currently used to treat acute variceal bleeds and also in the long-term management after a variceal bleed. The technical variants and results of sclerotherapy in both settings are reviewed and compared with alternative surgical treatment options. Sclerotherapy has become an accepted therapy for acute variceal bleeding. In Cape Town it is used in combination with the Sengstaken tube. A preliminary analysis of an ongoing trial comparing a rigid scope technique with a fibreoptic scope technique provides support for the use of the rigid scope in acute variceal bleeding. The place of repeated sclerotherapy in long-term management has become controversial. Varices can be eradicated and repeated variceal bleeds markedly reduced, but its role in improving survival requires further clarification.

Topics: Acute Disease; Combined Modality Therapy; Esophageal and Gastric Varices; Esophagoscopes; Gastrointestinal Hemorrhage; Gastroscopes; Humans; Oleic Acids; Portasystemic Shunt, Surgical; Sclerosing Solutions; Sodium Morrhuate

Several clinical studies of prophylactic therapy for esophageal varices have led to the conclusion that prophylactic therapy is of no value, and it is generally not accepted in the Western world. However, this is not the case in Japan. The present study evaluated the efficacy of prophylactic endoscopic injection sclerotherapy (EIS) in patients with unresectable hepatocellular carcinoma (HCC) and risky esophageal varices.. Twenty-seven patients with 'likely-to-bleed' esophageal varices concomitant with unresectable HCC were randomly allocated to two groups. Thirteen patients underwent prophylactic EIS (EIS group), whereas the remaining 14 patients were observed conservatively (control group).. No bleeding from esophageal varices occurred in the EIS group during the entire period of this study, whereas in thecontrol group the cumulative bleeding rate was 44.8% in 6 months. Cumulative survival rates of patients in the EIS group and in the control group were 48.8% and 7.7% in 2 years, respectively. There was a statistically significant difference between the two groups in cumulative bleeding rate and survival rate (P < 0.01).. This prospective study demonstrated that prophylactic EIS could prolong the survival of the patients with esophageal varices concomitant with unresectable HCC. Prophylactic EIS for patients with unresectable HCC may be, in part, justified according to the present study.

Topics: Adult; Aged; Carcinoma, Hepatocellular; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Incidence; Injections, Intralesional; Japan; Liver Neoplasms; Male; Middle Aged; Oleic Acids; Prospective Studies; Risk Factors; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Bleeding internal haemorrhoids are common and used to be treated surgically with too many complications. Endoscopic therapy is trying to take the lead. Sclerotherapy and rubber band ligation are the candidates to replace surgical therapy especially in patients with liver cirrhosis. The aim of this study was to compare endoscopic injection sclerotherapy (EIS) to endoscopic rubber band ligation (EBL) regarding effectiveness and complications in the treatment of bleeding internal haemorrhoids in Egyptian patients with liver cirrhosis.. One hundred and twenty adult patients with liver cirrhosis and bleeding internal haemorrhoids were randomised into two equal groups; the first treated with EBL using Saeed multiband ligator, and the second with EIS using either ethanolamine oleate 5% or N-butyl cyanoacrylate. All groups were matched as regards age, sex, Child score and pre-procedure Doppler values. Patients were followed up clinically and with abdominal ultrasound/Doppler for 6 months. Endoscopic and endosonography/Doppler was done before and one month after the procedure. Pre and post-procedure data were recorded and analysed.. Both techniques were highly effective in the control of bleeding from internal haemorrhoids with a low rebleeding [10% in the EBL group and 13.33% in the EIS group] and recurrence [20% in the EBL group 20% in the EIS group] rates. Child score had a positive correlation with rebleeding and recurrence in EIS group only. Pain score and need for analgesia were significantly higher while patient satisfaction was significantly lower in EIS compared to EBL [p<0.05]. No significant difference between ethanolamine and cyanoacrylate subgroups was found [p>0.05].. Both EBL and EIS were effective in the treatment of bleeding internal haemorrhoids in patients with liver cirrhosis. EBL had significantly less pain and higher patient satisfaction than EIS. EBL was also safer in patients with advanced cirrhosis.

Topics: Adult; Chi-Square Distribution; Enbucrilate; Endosonography; Female; Gastrointestinal Hemorrhage; Hemorrhoids; Humans; Ligation; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Pain, Postoperative; Patient Satisfaction; Proctoscopy; Recurrence; Sclerosing Solutions; Sclerotherapy

Our study aimed to evaluate the therapeutic results of endoscopic N-butyl-2-cyanoacrylate injection (EBC) and balloon-occluded retrograde transvenous obliteration (BRTO) in patients with gastric variceal hemorrhage (GVH) and/or high-risk gastric varices (GV).. Twenty-seven patients with GVH and/or high-risk GV (>or= 5 mm in diameter, those with red spots, and a Child-Pugh grading of B or C liver cirrhosis) who were treated with either EBC or BRTO from April 2005 to December 2007 were included in our study.. EBC or BRTO was initially used for the treatment of GVH in 14 and 13 patients, respectively. Technical success was achieved in all 14 patients (100%) initially treated with EBC, and 10 of 13 patients (76.9%) initially treated with BRTO. Significant rebleeding occurred in 10 patients (71.4%) of the EBC group, and two patients (15.4%) of BRTO group (P < 0.01). Five of six patients (83.3%) treated with rescue BRTO due to rebleeding after initial EBC achieved technical success, and all six patients who were treated with rescue BRTO had no rebleeding during the median follow up of 17 (range: 2-37) months. The cumulative survival rate of the EBC with the BRTO rescue group/BRTO group was significantly higher than the EBC group.. The therapeutic efficacies of EBC and BRTO for the treatment of active GVH and/or high-risk GV appeared to be similar. However, EBC might be associated with a higher rebleeding rate than BRTO. BRTO could be an effective rescue treatment for patients with GVH after initial treatment of EBC.

Topics: Aged; Balloon Occlusion; Enbucrilate; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Injections, Intralesional; Kaplan-Meier Estimate; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Prospective Studies; Recurrence; Risk Assessment; Sclerosing Solutions; Severity of Illness Index; Time Factors; Tissue Adhesives; Treatment Outcome

The purpose of this paper is to describe our experience with endovascular obliteration of duodenal varices in patients with liver cirrhosis and portal hypertension. Balloon-occluded transvenous retrograde and percutaneous transhepatic anterograde embolizations were performed for duodenal varices in five patients with liver cirrhosis, portal hypertension, and decreased liver function. All patients had undergone previous endoscopic treatments that failed to stop bleeding and were poor surgical candidates. Temporary balloon occlusion catheters were used to achieve accumulation of an ethanolamine oleate-iopamidol mixture inside the varices. Elimination of the varices was successful in all patients. Retrograde transvenous obliteration via efferent veins to the inferior vena cava was enough to achieve adequate sclerosant accumulation in three patients. A combined anterograde-retrograde embolization was used in one patient with balloon occlusion of afferent and efferent veins. Transhepatic embolization through the afferent vein was performed in one patient under balloon occlusion of both efferent and afferent veins. There was complete variceal thrombosis and no bleeding was observed at follow-up. No major complications were recorded. Endovascular obliteration of duodenal varices is a feasible and safe alternative procedure for managing patients with portal hypertension and hemorrhage from this source.

Topics: Aged; Balloon Occlusion; Catheterization; Duodenum; Feasibility Studies; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Haptoglobins; Humans; Hypertension, Portal; Iopamidol; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Sclerosing Solutions; Treatment Outcome; Varicose Veins

Balloon-occluded retrograde transvenous obliteration of gastric varices by a microcatheter insertion method was performed in eight patients with large collateral veins or a large gastrorenal shunt. A 3-F microcatheter was selectively inserted into the gastric varices through a 6-F balloon catheter wedged in the left adrenal vein. Selective venography of the gastric varices and injection of the sclerosing agent, a mixture of 10% ethanolamine oleate and iopamidol, through the microcatheter system without occluding the collateral veins was accomplished in one treatment session in all patients. There have been no complications or recurrences of gastric varices in any of the patients during the follow-up period.

Topics: Aged; Balloon Occlusion; Collateral Circulation; Contrast Media; Esophageal and Gastric Varices; Female; Fluoroscopy; Gastrointestinal Hemorrhage; Humans; Iopamidol; Male; Middle Aged; Miniaturization; Oleic Acids; Portasystemic Shunt, Surgical; Sclerosing Solutions; Treatment Outcome

Forty consecutive patients with bleeding oesophageal varices underwent paravariceal injection with 2.5% or 5% ethanolamine oleate in a single-blind randomized controlled trial. Patients were injected on a weekly basis until varices were eradicated and then followed-up for a period of two years. Patients injected with 2.5% ethanolamine oleate experienced a significantly shorter duration of dysphagia and significantly less episodes of fever, ulceration, and luminal narrowing. Patients injected with 5% ethanolamine oleate required significantly less injection sessions to eradicate their varices. However, the probability of rebleeding was significantly lower in patients injected with 2.5% ethanolamine oleate. This study supports the use of ethanolamine in a concentration of 2.5% when injected paravariceally as it is associated with less complications and a lower probability of rebleeding.

Topics: Adult; Aged; Dose-Response Relationship, Drug; Endoscopy; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Recurrence; Schistosomiasis; Sclerosing Solutions; Sclerotherapy; Single-Blind Method; Treatment Outcome

No single effective method has yet been established for the prophylactic treatment of gastric fundal varices at high risk for bleeding. A prospective, randomized trial was conducted to compare the efficacy and safety of a new technique, balloon-occluded endoscopic injection sclerotherapy (BO-EIS), to balloon-occluded retrograde transvenous obliteration (B-RTO) for treatment of high-risk gastric fundal varices.. Twenty consecutive patients with gastric variceal diameters of over 5 mm by color Doppler EUS were randomized to undergo either BO-EIS or B-RTO. All patients underwent color Doppler EUS 2 weeks after treatment and EGD every 3 months for assessment of sclerosing effect.. The gastric varices in all patients except one in the B-RTO group were eradicated with either treatment. The volume of sclerosant used was significantly smaller in patients who underwent BO-EIS (p < 0.05). The endoscopic grade of esophageal varices in 4 of 9 patients worsened after treatment with B-RTO (p < 0.05). The method of randomization used resulted in an uneven distribution of women, although the difference between the groups was not statistically significant. When only men were compared, the results of the study were unchanged.. BO-EIS is a safe and effective for treatment of high-risk gastric fundal varices. In contrast to B-RTO, it can be used even in patients without a gastrorenal shunt.

Topics: Aged; Catheterization; Esophageal and Gastric Varices; Feasibility Studies; Female; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Ligation; Male; Middle Aged; Oleic Acids; Prospective Studies; Risk Factors; Safety; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

This study was performed to evaluate the clinical efficacy, feasibility, and complications of balloon-occluded retrograde transvenous obliteration for patients with hemorrhage from gastric fundal varices.. Between December 1994 and February 2001, 24 consecutive patients with hemorrhage from gastric fundal varices were enrolled in this study. Balloon-occluded retrograde transvenous obliteration consisted of injecting 5% ethanolamine oleate iopamidol through the outflow vessels during balloon occlusion. The treatment was performed during acute bleeding in 11 patients and electively in 13 patients. Among those patients with acute bleeding, six were treated for temporary hemostasis with balloon tamponade, and five were treated endoscopically.. Cannulation into the outflow vessels was performed in 23 patients, but the balloon catheter could not be inserted in one patient who had inferior phrenic vein outflow. Complete success was obtained in 88% (21/24) of patients, and partial success was obtained in two patients. In nine of 11 patients with acute bleeding, complete success was achieved. Rebleeding from gastric varices was not observed in patients treated with complete success, whereas two patients treated partially rebled within 1 week of the treatment (rate of rebleeding, 9%). Eradication of gastric varices was obtained in all patients (n = 19) who were examined by endoscopy 3 months after the treatment. Eight patients experienced worsening of esophageal varices. These patients were treated endoscopically because of findings that suggested a risk of hemorrhage. The overall mortality rate was 4% (1/24). No damage to the kidney was observed, although 11 patients had macrohematuria.. Balloon-occluded retrograde transvenous obliteration followed by any hemostatic procedure might be effective for both prophylaxis of rebleeding and eradication of gastric fundal varices, even in urgent cases.

Topics: Adult; Aged; Aged, 80 and over; Balloon Occlusion; Catheterization; Esophageal and Gastric Varices; Feasibility Studies; Female; Gastric Fundus; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Hemostasis, Surgical; Humans; Injections, Intravenous; Male; Middle Aged; Oleic Acids; Radiography; Retreatment; Sclerosing Solutions

Topics: Enbucrilate; Endoscopy; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Injections, Intralesional; Male; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Sensitivity and Specificity; Survival Rate; Treatment Outcome

In order to evaluate the prophylactic impact of sclerotherapy of small varices in patients with cirrhosis and no endoscopic signs suggesting risk of haemorrhage, a randomized clinical trial was performed.. Seventy-one hospitalized patients met the inclusion criteria of diagnosis of cirrhosis with no previous bleeding and small varices. Due to exclusion criteria of: gastroduodenal ulcers (n = 5), diverticulosis (n = 1), hepatic insufficiency (n = 10), hepatocellular carcinoma (n = 4), death before randomization (n = 6), age over 70 (n = 1) and denial of consent to participate in the study (n = 1), 43 patients could be randomized, 21 for sclerotherapy and 22 for the control group. Two patients (one in each group) were lost to follow up, and another patient, although not lost, refused sclerotherapy after randomization. Ethanolamine oleate was used as the sclerosing agent. All patients were followed up for a mean time of 60 months, initially every 2 months for the first 2 years and clinical and endoscopic controls were performed each 6-12 months thereafter.. During the first 2 years clinical assessment showed that there were five bleedings in the sclerotherapy group and none in the control group, but mortality was similar in both groups. Long-term follow up continued to show a higher prevalence of bleeding in the sclerotherapy group but that mortality was not different from the control group.

Topics: Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Prevalence; Risk Factors; Sclerosing Solutions; Time Factors

To evaluate the efficacy of endoscopic variceal ligation (EVL) in prophylactic therapy for oesophageal varices, we performed a randomized prospective trial to compare the recurrence of oesophageal varices treated by EVL with those treated by endoscopic injection sclerotherapy.. Fifty patients with liver cirrhosis were divided into two groups at random, after informed consents were obtained, to receive prophylactic therapy for bleeding of oesophageal varices. Group 1 patients underwent sessions of sclerotherapy with 5% ethanolamine oleate used as the sclerosant. Group 2 patients underwent EVL followed by one or two sessions of sclerotherapy.. During the 18 month follow-up period, both the recurrence rate in group 2 (56%) and the incidence of bleeding (20%) were significantly higher compared with group 1 (recurrence rate 16%, bleeding 0%).. This result indicates that EVL is not effective for prophylactic therapy for oesophageal varices in liver cirrhosis.

Topics: Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Ligation; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Prospective Studies; Recurrence; Sclerosing Solutions; Time Factors

We devised a new combined method of endoscopic variceal ligation and injection sclerotherapy, namely, endoscopic scleroligation, for the treatment of esophageal varices. The aim of this prospective randomized trial was to compare endoscopic scleroligation with endoscopic variceal ligation alone with regard to efficacy, complications, variceal recurrence, and survival.. Fifty-one patients with cirrhosis and esophageal varices were randomly assigned to be treated by endoscopic scleroligation (n = 25) or endoscopic variceal ligation (n = 26). In the initial session in the endoscopic scleroligation group, endoscopic injection sclerotherapy was performed with injection of 5% ethanolamine oleate around the lower esophagus to obliterate the feeding veins. This was followed by endoscopic variceal ligation from the injection site to the most orad varix. In subsequent sessions, endoscopic injection sclerotherapy was performed with 1% polidocanol. In the endoscopic variceal ligation group, that procedure was performed in all treatment sessions.. Both methods were equally effective in achieving complete eradication of esophageal varices. Among the cases in which complete eradication was achieved, the 1- and 3-year cumulative recurrence rates in the endoscopic scleroligation group (9.5%, 22.1%) were significantly lower than those in the endoscopic variceal ligation group (61.9%, 72.2%) (p < 0.01). The survival rates and incidences of treatment-related complications have been similar among patients treated by both methods.. Endoscopic scleroligation is superior to endoscopic variceal ligation in preventing variceal recurrence.

Topics: Aged; Combined Modality Therapy; Endoscopy; Esophageal and Gastric Varices; Esophagoscopy; Gastrointestinal Hemorrhage; Humans; Iopamidol; Ligation; Liver Cirrhosis; Middle Aged; Oleic Acids; Prospective Studies; Recurrence; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Topics: Drug Therapy, Combination; Esophageal and Gastric Varices; Esophagoscopy; Fibrin Tissue Adhesive; Gastrointestinal Hemorrhage; Hemostatics; Humans; Injections, Intralesional; Liver Cirrhosis; Oleic Acids; Sclerosing Solutions; Secondary Prevention; Treatment Outcome

Cyanoacrylate injection is highly effective and is regarded as the treatment of choice in bleeding gastric varices in Europe, but intravenous injection of cyanoacrylate is not allowed in the USA and Japan because it may cause embolisms in other organs. Accordingly, we developed a new endoscopic combined treatment of endoscopic management of gastric varices using a detachable snare (EVLs) and simultaneous endoscopic sclerotherapy and O-ring ligation (EISL) (i.e. EVLs + EISL), and we prospectively evaluated its efficacy and safety.. Gastric varices were ligated with the loop of a detachable snare that opened to a diameter of 4 cm (EVLs). Then the residual varices around the ligated portion were sclerosed by ethanolamine oleate and the injected vessel was ligated using a pneumo-activated EVL device (EISL). The EVLs + EISL was performed in 35 patients: on an emergency basis in eight patients, on an elective basis in six patients and as primary prophylaxis in 21 patients. Liver function was classified as Child-Pugh class A in 12 patients, class B in 12 patients and class C in 11 patients.. Endoscopic disappearance of gastric varices was obtained in 97.1% of the patients and they regressed in all patients. Haemostasis was achieved in all eight emergency cases. The 2-year cumulative non-recurrence rate was 85%, the 2-year cumulative non-bleeding rate was 92% and the 2-year cumulative survival was 80%. No patients died of bleeding from gastric varices. There were no serious short-term complications, such as haemorrhage, gastro-oesophageal perforation, ileus, or renal impairment.. Combined EVLs + EISL appears to be a useful treatment for gastric varices due to its safety and good clinical outcome.

Topics: Endoscopy; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Ligation; Male; Middle Aged; Oleic Acids; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Survival Rate; Treatment Outcome

The present study was conducted to compare usual sclerosants: polidocanol 1%, ethanolamine oleate 5% and the tissue adhesive: cyanoacrylate in the control of oesophageal variceal bleeding in Egyptian patients with portal hypertension in a prospective comparative trial. Sixty patients with portal hypertension due to schistosomal hepatic fibrosis and/or posthepatitic liver cirrhosis who had presented with acute oesophageal variceal bleeding were enrolled. Patients received balloon tamponade prior to injection were excluded. Resuscitation had been done before or during emergency endoscopy. Emergency endoscopy was conducted within 2 hours from the onset of hematemesis. Patients were immediately randomized during emergency endoscopy to receive polidocanol 1%, ethanolamine oleate 5% or tissue adhesive. Variceal rebleeding was managed by reinjection. The three groups were comparable for age, sex, etiology of portal hypertension, Child-Pugh class and findings at emergency endoscopy. No active bleeding was observed at the end of all injection sessions. Rebleeding had been occurred within the first 24 hours in 2 (10%) patients in polidocanol group and 3 (15%) patients in ethanolamine group (P > 0.05). Reinjection did control rebleeding in 2 (10%) patients in ethanolamine group with a total success rate of 95%. Exsanguinating rebleeding occurred in 2 (10%) patients in polidocanol group and one (5%) patient in ethanolamine group (P > 0.05). Postinjection large ulcers were diagnosed either in polidocanol (15%) or ethanolamine (10%) groups (P > 0.05). Other complications were minor and showed no significant differences between the three groups. In coclusion, polidocanol, ethanolamine and cyanoacrylate are equally safe and effective. For immediate endoscopic injection therapy an experienced team must be available.

Topics: Cyanoacrylates; Egypt; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Male; Oleic Acids; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions

Endoscopic sclerotherapy and banding ligation are the two preferred methods to treat oesophageal variceal bleeding. There are many reports dealing with such treatment in cirrhotic patients but we do not know how good they are to treat varices secondary to other forms of portal hypertension. Schistosomiasis mansoni is the main cause of portal hypertension and oesophageal varices in Brazil. We performed a prospective randomised study to compare: 1) the efficacy of both treatments in eradicating oesophageal varices, and 2) complications secondary to both treatments. Forty patients were divided in two groups. Both sclerotherapy and banding ligation were performed until variceal eradication. There were no severe complications. Variceal eradication was faster obtained with banding ligation than sclerotherapy although there was no statistical difference (mean number of sessions 3.05 vs 3.72, p = 0.053). Benign complications were equally frequent in both groups, although additional sedation was more common in the sclerotherapy group. We concluded that both treatments are equally effective in the eradication of oesophageal varices, although banding ligation is better tolerated by the patient and probably faster.

Topics: Adult; Aged; Endoscopy; Esophageal and Gastric Varices; Esophagoplasty; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Ligation; Male; Middle Aged; Oleic Acids; Prospective Studies; Schistosomiasis mansoni; Sclerosing Solutions; Sclerotherapy; Statistics, Nonparametric

Sclerotherapy may be useful in patients with bleeding gastric varices. The aim of this study was to compare the effects of two sclerosants in these patients.. In a prospective nonrandomized trial, we performed single sclerotherapy for bleeding gastric varices using ethanolamine oleate (n = 24) or butyl cyanoacrylate (n = 29). The patients were followed for a mean of 14 months.. The rate of initial hemostasis (no bleeding occurred for 48 hours after sclerotherapy) was significantly higher in the butyl cyanoacrylate group (93%) than in the ethanolamine oleate group (67%) (p = 0.014). The rate of initial hemostasis in cardiac variceal bleeding did not differ significantly between the ethanolamine oleate and butyl cyanoacrylate groups (83% vs. 100%, p = 0.140). In contrast, the hemostasis rate for fundal variceal bleeding was significantly higher in the butyl cyanoacrylate group than in the ethanolamine oleate group (88% vs. 50%, p = 0.023). Although the rebleeding rate did not differ between the two groups (30% vs. 25%, p = 0.921), the mortality rate was significantly higher in the ethanolamine oleate group (67% vs. 38%, p = 0.043). In addition, the incidence of complications in the butyl cyanoacrylate group was similar to that in the ethanolamine oleate group (46% vs. 41%, p = 0.745).. These results suggest that initial control of fundal varices is more difficult than it is with cardiac varices, but butyl cyanoacrylate is superior to ethanolamine oleate, and the survival advantage from butyl cyanoacrylate seems to be partially related to the increased early bleeding deaths in the ethanolamine oleate group.

Topics: Adult; Aged; Enbucrilate; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Survival Rate; Treatment Outcome

Recently, tissue adhesive material has been used to improve the initial control of bleeding from huge esophagogastric varices, and to prevent them from rebleeding, in contrast to the conventional sclerotherapy. The present study assessed the value of the combined use of the tissue adhesive substance: N-butyl-2-cyanoacrylate and ethanolamine oleate 5% for management of bleeding esophagogastric varices.. One hundred and fourteen patients with documented active variceal bleeding at the time of endoscopy were alternatively randomized into two groups. The combined therapy group included 58 patients who underwent injection using both cyanoacrylate for large esophageal and gastric varices and a sclerosant agent for remaining varices. The sclerosis, or control, group included 56 patients, who underwent injection with ethanolamine oleate.. This study proved the value of the combined therapy for the initial control of all bleeders (the follow-up period ranged from 12 to 32 months). In the sclerosis group, failure of the initial control of bleeding was reported in two cases (3.6%). Recurrent bleeding occurred in 8.6% in the combined therapy group compared to 25% in the sclerosis group (p < 0.01). Two months of therapy was required to achieve complete eradication of varices in 56.5% and 21.4% in the combined therapy and the sclerosis group, respectively. The mean number of sessions needed until the time of evaluation was 2.4 +/- 1.1 in the combined therapy group versus 5.1 +/- 2.3 sessions in the sclerosis group. The difference showed high statistical significance (p < 0.01). Minor complications occurred less frequently in the combined therapy group. Only one patient in the combined therapy group developed portal pyemia after extension of the tissue adhesive material from the site of injection into the portal vein. This patient died of hepatic failure. The mortality in the combined therapy group was lower than that in the sclerosis group (3.5% and 8.8% respectively, p > 0.05).. The combined use of tissue adhesive and sclerosant materials seems to be the best plan for rapid eradication of esophagogastric varices within a short time, requiring the lowest number of injection sessions and involving minor complications and low mortality.

Topics: Adult; Aged; Enbucrilate; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Outcome

N-2-cyanoacrylate (Histoacryl) and endoscopic sclerotherapy with polidocanol have both been reported to control variceal bleeding. The aim of the present study was to compare the effectiveness of the combination of Histoacryl and endoscopic sclerotherapy with polidocanol in the management of these patients regarding early rebleeding and hospital mortality rates.. One hundred twenty-six consecutive patients with variceal hemorrhage treated with injection therapy between March 1990 and July 1993 were included in this randomized prospective study. Sixty-seven patients (Group A) were treated with Histoacryl and conventional sclerotherapy with polidocanol, and 59 patients (Group B) were treated with conventional sclerotherapy with polidocanol alone. Histoacryl was injected intravariceally during the first session in the Group A patients.. A significantly lower bleeding recurrence rate was found in Group A patients who presented with active bleeding at the first treatment session (Group A: 2 of 20, Group B: 8 of 18, p < 0.05). The hospital mortality was also significantly lower in these patients (Group A: 3 of 21, Group B: 9 of 18, p < 0.05).. The combination of Histoacryl with conventional sclerotherapy with polidocanol in patients with esophageal bleeding who present with active bleeding, at the initial injection therapy, can improve the results of endoscopic management.

Topics: Adult; Enbucrilate; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

The efficacy and side effects of 3% sodium tetradecyl sulphate (STD) and 5% ethanolamine oleate (ETH) were compared in 95 patients admitted with variceal bleeding. The patients were allocated in a randomised fashion to one of the treatment groups when varices were identified which were either actively bleeding or had signs of recent haemorrhage. Endoscopic examination was performed within 24 hours of admission. The endoscopist had no knowledge of which sclerosant was used. Intravariceal injections of 2 ml aliquots up to a maximum of 20 ml were made in a double-blinded manner. Repeat injections were performed at weekly intervals until all oesophageal varices were obliterated. Bleeding was successfully controlled in 42/48 (87.5%) patients in the STD group and 41/47 (87.2%) patients in the ETH group after one session of therapy. Variceal obliteration was achieved after 3.3 +/- 1.3 sessions of STD and 4.5 +/- 1.9 sessions of ETH (p < 0.05 Student's t-test). Post-injection pyrexia was significantly more common in the STD group (42% vs 30% p < 0.05, chi-square test). There was no difference in the rates of subsequent oesophageal ulceration, stricture formation or perforation of the oesophagus. It is concluded that STD and ETH are both effective in controlling variceal haemorrhage, but STD obliterates the varices in significantly fewer sessions.

Topics: Double-Blind Method; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Sodium Tetradecyl Sulfate

Topics: Clinical Trials as Topic; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Oleic Acids; Recurrence; Sclerosing Solutions

Forty-five cirrhotic patients with oesophageal varices underwent endoscopic injection sclerotherapy in a prospective randomized trial carried out to compare two sclerosing agents (5 per cent ethanolamine oleate and 2 per cent sodium tetradecyl sulphate (STD] with respect to safety, efficacy and complications. Twenty-three patients were allocated to the ethanolamine group and twenty-two to the STD group. The rate of control of acute bleeding was 100 per cent (6/6) in the ethanolamine group and 75 per cent (3/4) in the STD group. There was a significantly lower rate of postinjection bleeding after the over-tube was removed at the initial session of sclerotherapy when ethanolamine was injected 0/23 versus 7/22, 32 per cent; P less than 0.01) and at the second session there was a significantly (P less than 0.01) higher rate of jet-like bleeding from injection sites in the STD group (6/21, 29 per cent) than in the ethanolamine group (0/22). The disappearance rate of red colour signs 1 week after the initial session of sclerotherapy in the ethanolamine group was 100 per cent and 62 per cent in the STD group. Early oesophageal ulcers developed less frequently in the ethanolamine group (0 and 9 per cent) than in the STD group (24 per cent and 43 per cent both after the initial (P less than 0.05) and the second session of sclerotherapy (P less than 0.01]. Early bleeding from an oesophageal ulcer occurred only in the STD group (5/21, 24 per cent) before the third session of sclerotherapy (P less than 0.05). The rate of early mortality did not differ between the two groups. We conclude that ethanolamine seems to be safer and more efficacious than STD for sclerosing oesophageal varices.

Topics: Clinical Trials as Topic; Endoscopy; Esophageal and Gastric Varices; Ethanolamines; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Prospective Studies; Random Allocation; Sclerosing Solutions; Sodium Tetradecyl Sulfate

Topics: Adult; Clinical Trials as Topic; Esophageal and Gastric Varices; Ethanol; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Prospective Studies; Sclerosing Solutions

Forty-seven patients with esophageal variceal bleeding were randomly allocated to undergo sclerotherapy on a 3 weekly schedule with either 5% ethanolamine oleate (23 patients) or absolute alcohol (24 patients), in an attempt to compare the efficacy and safety of the two sclerosants. Sclerotherapy with absolute alcohol eradicated esophageal varices significantly earlier compared with ethanolamine oleate (12.9 +/- 5.2 vs 22.3 +/- 8.2 wk, respectively, p less than 0.001). The mean number of injection courses and the mean amount of sclerosant required for variceal obliteration was also significantly (p less than 0.001) less in the alcohol-injected group. Although the total number of rebleeding episodes were significantly (p less than 0.05) less in the alcohol-injected group, the frequency of rebleeding was not significantly different between the two groups (20.8% vs 30.4%, respectively, p greater than 0.05). Two (8.1%) patients died due to rebleeding in the ethanolamine-injected group, whereas in the alcohol group, none died. There was no significant difference in the frequency of complications with the two sclerosants. Besides the relative ease of rapid injection due to its aqueous nature, alcohol is readily available and relatively economical (total cost of sclerosant per patient; alcohol US $0.50, ethanolamine US $60). In conclusion, absolute alcohol appears to be a useful alternative to 5% ethanolamine oleate as a variceal sclerosant.

Topics: Adult; Clinical Trials as Topic; Esophageal and Gastric Varices; Ethanol; Female; Gastrointestinal Hemorrhage; Humans; Male; Methods; Oleic Acids; Prospective Studies; Random Allocation; Sclerosing Solutions

Oesophageal varices are the commonest cause of acute upper gastrointestinal bleeding in Egypt, due to the prevalence not only of schistosomiasis but also chronic hepatitis. Poor results of conventional treatment and shunt surgery led us to evaluate injection sclerotherapy, using fibreoptic endoscopy. In a controlled trial, 108 patients were randomly allocated to injection sclerotherapy or to conventional treatment (medical measures, with modified splenectomy and oesophagogastric devascularization in selected cases). We report the results in the first 108 patients, with a follow-up of 1-35 months. Fifty-three patients received injection sclerotherapy; 5 died (2 of recurrent bleeding) and 5 others had recurrent bleeding but were controlled by further injections. Thirty-six of the 55 control patients underwent surgery; 5 died (2 of recurrent bleeding) and 2 others developed recurrent bleeding. Further bleeding occurred in 12 of the 19 patients who were managed by medical measures alone, with 7 dying. These early results indicate that injection sclerotherapy can be effective in urgent and elective situations and that it appears to have advantages over conventional medical and surgical treatments.

Topics: Acute Disease; Adolescent; Adult; Aged; Clinical Trials as Topic; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Middle Aged; Oleic Acids; Random Allocation; Recurrence; Sclerosing Solutions; Splenectomy

Endoscopic injection sclerotherapy (EIS) is effective for temporary hemostasis, but EIS and balloon-occluded retrograde transvenous obliteration (BRTO) have been reported as effective for secondary prophylaxis of gastric varices (GV) bleeding. This study retrospectively compared EIS and BRTO in patients with GV in terms of the efficacy for secondary prevention of GV bleeding and effects on liver function.. From our database of patients with GV who underwent EIS or BRTO between February 2011 and April 2020, a total of 42 patients with GV were retrospectively enrolled. The primary endpoint was the bleeding rate from GV, which was compared between EIS and BRTO groups. Secondary endpoints were liver function after treatment and rebleeding rate from EV, compared between EIS and BRTO groups. Rebleeding rates from GV and EV and liver function after treatment were also compared between EIS-ethanolamine oleate (EO)/histoacryl (HA) and EIS-HA groups.. Technical success was achieved for all EIS cases, but two cases were unsuccessful in the BRTO group and underwent additional EIS. No significant differences in bleeding rates or endoscopic findings for GV improvement were seen between EIS and BRTO groups. Liver function also showed no significant difference in the amount of change after treatment between groups.. EIS therapy appears effective for GV in terms of preventing GV rebleeding and effects on liver function after treatment. EIS appears to represent an effective treatment for GV.

Topics: Balloon Occlusion; Enbucrilate; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Retrospective Studies; Time Factors; Treatment Outcome

To compare the clinical outcomes of balloon-occluded retrograde transvenous obliteration (BRTO) using ethanolamine oleate (EO), BRTO using sodium tetradecyl sulfate (STS) foam, and vascular plug-assisted retrograde transvenous obliteration (PARTO).. From April 2004 to February 2015, ninety-five patients underwent retrograde transvenous obliteration for gastric varices were analyzed retrospectively. BRTO with EO was performed in 49 patients, BRTO with STS foam in 25, and PARTO in 21. Among them, we obtained follow-up data in 70 patients. Recurrence of gastric varices was evaluated by follow-up endoscopy or CT. Medical records were reviewed for the clinical efficacy. Statistical analyses were performed by Kaplan-Meier method, Chi-square, Fisher's, and Kruskal-Wallis tests.. Technical and clinical success was 94.7 %. As major complications, a hemoglobinuria and a death due to disseminated intravascular coagulation (DIC) were occurred in two patients with BRTO using EO. Recurrence occurred more frequently in PARTO group (P < 0.05). Recurrence occurred in three patients in BRTO using EO group and four patients in PARTO group with 3.2 and 32.8 % of each expected 1-year recurrence rates. There was no recurrence in BRTO using STS group. Abdominal pain occurred more frequently in BRTO using EO than BRTO using STS foam and PARTO (P < 0.05). Procedure time of PARTO was shorter than two conventional BRTOs (P < 0.05).. BRTO using STS foam or PARTO is better than BRTO using EO for treatment of gastric varices in terms of complication or procedure time. However, PARTO showed frequent recurrence of gastric varices during the long-term follow-up rather than BRTO.

Topics: Adult; Aged; Balloon Occlusion; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Retrospective Studies; Sclerosing Solutions; Sodium Tetradecyl Sulfate; Treatment Outcome

This study aims to clarify the long-term outcome of therapeutic strategies including balloon-occluded retrograde transvenous obliteration (B-RTO) for patients with gastric fundal varices.. The subjects were 154 patients with gastric fundal varices fulfilling the criteria for receiving B-RTO. In patients showing variceal bleeding, endoscopic therapies and/or balloon tamponade was performed to achieve hemostasis. B-RTO was accomplished with injection of 5% ethanolamine oleate through a standard balloon catheter except for patients with atypical varices, in whom a microballoon catheter was used to occlude drainage vessels other than a gastrorenal shunt. In patients complicated with esophageal varices at baseline, endoscopic therapies were performed following B-RTO.. Balloon-occluded retrograde transvenous obliteration was performed successfully in 147 patients (95%), including 15 patients using a microballoon catheter. Complete variceal obliteration was achieved in all patients. Additional endoscopic therapies for esophageal varices were performed in 31 patients. Gastric varices did not recur in any of these patients. The cumulative survival rates at 1, 3, and 5 years after B-RTO were 91%, 76%, and 72%, respectively. Child-Pugh scores and hepatocellular carcinoma complication were identified as prognostic factors associated with survival rates. The cumulative exacerbation rates of esophageal varices at 1, 3, and 5 years were 13%, 20%, and 27%, respectively, and rupture developed in six patients, which were successfully treated with endoscopic therapies.. Therapeutic strategies including B-RTO with a microballoon catheter were useful to achieve a favorable outcome in patients with gastric fundal varices especially in those manifesting Child-Pugh class-A liver damage and/or those without hepatocellular carcinoma complication.

Topics: Adult; Aged; Aged, 80 and over; Balloon Occlusion; Esophageal and Gastric Varices; Female; Gastric Fundus; Gastrointestinal Hemorrhage; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Oleic Acids; Retrospective Studies; Sclerosing Solutions; Treatment Outcome

We evaluated the efficacy and safety of balloon-occluded retrograde transvenous obliteration (B-RTO) performed using absolute ethanol with iodized oil (ET+LPD) and simultaneous endoscopic injection sclerotherapy (EIS) with cyanoacrylate (CA) for gastric varices (GVs).. A total of 16 patients with endoscopically proven high-risk GVs treated using combined B-RTO with ET+LPD and EIS with CA between January 2007 and July 2012 were enrolled.. Twelve cases included GVs involving both the cardia and fundus, two cases included fundal varices and two cases included cardiac varices. In terms of the form of GVs, 10 cases involved F2 lesions and six cases involved F3 lesions. The flow vein was the left gastric vein in 13 cases and the posterior gastric vein in three cases. The drainage route was a splenorenal shunt in all cases. The average dose of ET+LPD was 12.0 mL, while that of CA was 2.45 mL. All complications were transient, and no major complications occurred after the procedures. None of the patients experienced bleeding or recurrence of gastric varices after the combined B-RTO and EIS procedures during an average follow-up period of 38.3 months.. Combined B-RTO with ET+LPD and simultaneous EIS with CA is considered to be an effective and safe procedure for treating GVs.

Topics: Adult; Aged; Balloon Occlusion; Cyanoacrylates; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Female; Gastric Fundus; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Injections, Intralesional; Male; Middle Aged; Oleic Acids; Recurrence; Risk Factors; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Isolated gastric varices (IGV) have a lower risk of bleeding than esophageal varices, however IGV bleeding is associated with a higher mortality than bleeding of esophageal varices. In recent years, two widely used treatments for IGV have been balloon-occluded retrograde transvenous obliteration (B-RTO) and endoscopic injection sclerotherapy (EIS) using cyanoacrylate or ethanolamine oleate (EO). This study compared these two treatment methods for IGV. The subjects were 112 patients who were treated at our hospital for IGV bleeding between October 1990 and December 2003. Forty-nine (49) patients were treated with B-RTO and 63 patients with EIS. These two patient groups were compared as regards content of treatment, post-treatment incidence of variceal bleeding, incidence of IGV rebleeding, survival rate, cause of death, and complications. Multivariate analysis was performed on post-treatment variceal bleeding and survival. Although EO was used in higher amounts in the B-RTO group than in the EIS group, the B-RTO group had a significantly lower number of treatment sessions and a significantly shorter treatment period (p<0.05). The EIS group had significantly more patients with IGV rebleeding after treatment than the B-RTO group. Treatment method was the only independent prognostic factor of IGV bleeding after treatment (p=0.024). The two groups did not differ significantly in the percentage of patients with aggravated esophageal varices after treatment. Bleeding from ectopic varices was not observed in any patient. There was no significant difference in survival by treatment method. The presence of hepatocellular carcinoma was the only independent prognostic factor for survival (p=0.003). It is concluded that B-RTO was more effective than EIS in the eradication of IGV and prevention of IGV recurrence and rebleeding.

Topics: Aged; Balloon Occlusion; Cyanoacrylates; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Injections; Japan; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Oleic Acids; Proportional Hazards Models; Recurrence; Risk Factors; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Outcome

A 56-year-old male with alcohol-induced liver cirrhosis developed rectal varices. He had a prior history of treatment for esophageal varices with endoscopic variceal ligation. Despite the repeated treatment for rectal varices with endoscopic variceal ligation, endoscopic injection sclerotherapy, and surgery, the bleeding from the rectal varices could not be controlled. Multidetector-row computed tomography and 3D-angiography revealed the hemodynamic profile of the rectal varices. We next approached the rectal varices through the umbilical vein on the abdominal wall, and successfully embolized the varices continuing from the inferior mesenteric vein using coils and a 5% solution of ethanolamine oleate with iopamidol.

Topics: Endoscopy; Gastrointestinal Hemorrhage; Humans; Injections, Intralesional; Male; Middle Aged; Multidetector Computed Tomography; Oleic Acids; Rectal Diseases; Rectum; Sclerosing Solutions; Sclerotherapy; Umbilical Veins; Varicose Veins

The outcome of sclerotherapy for bleeding oesophageal varices may be influenced by injection technique. In a previous study at our institution, sclerotherapy was associated with a high re-bleeding rate and oesophageal ulceration. Embolisation of the injection tract was introduced in an attempt to reduce injection-related complications.. To determine the outcome and effectiveness of injection tract embolisation in reducing injection-related complications, we retrospectively reviewed a series of 59 children who underwent injection sclerotherapy for oesophageal varices (29 for extrahepatic portal vein obstruction (EHPVO) and 30 for intrahepatic disease) in our centre.. Sclerotherapy resulted in variceal eradication in only 11.8% of the children (mean follow-up duration: 38.4 months). Variceal eradication with sclerotherapy alone was achieved in 20.7% and 3.3% of EHPVO and intrahepatic disease patients, respectively. Injection tract embolisation was successful in reducing the number of complications and re-bleeding rates. Complications that arose included: transient pyrexia (16.7%); deep oesophageal ulcers (6.7%); stricture formation (3.3%); and re-bleeding before variceal sclerosis (23%).. Injection sclerotherapy did not eradicate oesophageal varices in most children. Injection tract embolisation by sclerosant was associated with fewer complications and reduced re-bleeding rates.

Topics: Child; Child, Preschool; Embolization, Therapeutic; Endoscopy; Esophageal and Gastric Varices; Female; Gastrointestinal Agents; Gastrointestinal Hemorrhage; Humans; Infant; Male; Octreotide; Oleic Acids; Sclerosing Solutions; Sclerotherapy

A 75-year-old man with portal hypertension was referred to our institution because he suddenly began to pass a large amount of tarry stool. Arterial portography and computed tomography (CT) during arterial portography via the superior mesenteric artery, using a unified 64-slice multidetector row CT and angiography system, revealed bleeding ileal varices. The varices were supplied blood by a single ileal vein and drained by dilated veins in the abdominal wall. The bleeding was successfully arrested by performing percutaneous transhepatic sclerotherapy with 12 ml of 5% ethanolamine oleate. The blood flow to the varices was controlled by balloon occlusion, and microcoils were inserted into the varices and supplying vein. No complications or rebleeding occurred during the 13-month follow-up period, and CT images obtained during follow-up showed that the varices had disappeared.

Topics: Abdomen; Aged; Balloon Occlusion; Contrast Media; Diagnosis, Differential; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Ileum; Image Enhancement; Iopamidol; Male; Oleic Acids; Portography; Postoperative Complications; Reoperation; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome; Varicose Veins

We report a case of successful embolization of jejunal varices that were the cause of massive gastrointestinal bleeding from a choledochojejunostomy site, resulting from obstruction of the extrahepatic portal vein. A 42-year-old man who had undergone choledochojejunostomy for intrahepatic and choledochal stones was readmitted after he started passing massive dark bloody stools. Gastrointestinal endoscopic examination and angiography could not identify the source of bleeding. Percutaneous transhepatic portography showed obstruction of the right branches of the portal vein. The formation of jejunal varices at the site of choledochojejunostomy was revealed by portography and by cholangioscopy, suggesting the varices as the cause of massive bleeding. Bleeding could not be controlled long-term by cholangioscopic sclerosing therapy. We finally stopped the bleeding by embolizing a jejunal vein to the afferent loop.

Topics: Adult; Angioscopy; Choledochostomy; Embolization, Therapeutic; Gastrointestinal Hemorrhage; Humans; Iopamidol; Jejunal Diseases; Jejunum; Male; Oleic Acids; Portal Vein; Varicose Veins

Topics: Collateral Circulation; Contrast Media; Endoscopy, Gastrointestinal; Endosonography; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Iopamidol; Jejunum; Male; Middle Aged; Oleic Acids; Portasystemic Shunt, Transjugular Intrahepatic; Sclerosing Solutions; Sclerotherapy; Stents; Tomography, X-Ray Computed; Varicose Veins

The prognostic factors, including gastric variceal bleeding itself, in patients with gastric varices (GV) after endoscopic treatment remain unclear. The aim of this study was to analyze prognostic factors in patients with GV after endoscopic treatment as well as to evaluate safety and efficacy of our endoscopic treatment.. This study enrolled 115 patients who underwent endoscopic treatment for GV between October 1988 and December 2003 using cyanoacrylate and 5% ethanolamine oleate. Successful hemostasis, recurrence rates, rebleeding rates, survival rates, complications and prognostic factors after the treatment were retrospectively reviewed.. Treatment sessions for GV were performed 3.4 +/- 2.5 times. All cases, including 14 emergency cases, were treated successfully. The cumulative recurrence rates at 1, 3 and 5 years after the treatment were 7.0%, 15.6% and 20.0%, respectively, and the cumulative rebleeding rates at 1, 3 and 5 years were 3.5%, 8.7% and 14.8%, respectively. The overall survival rates were 78.3%, 63.7% and 51.5% at 1, 3 and 5 years, respectively. Grade B or C in Child-Pugh classification, emergency or elective cases, and association with hepatocellular carcinoma were identified as significant negative prognostic factors after endoscopic treatment by multivariate analysis. Although several complications were observed, there was no mortality.. Grade B or C in Child-Pugh classification, emergency or elective situation, and association with hepatocellular carcinoma are negative prognostic factors after endoscopic treatment.

Topics: Aged; Cohort Studies; Cyanoacrylates; Endoscopy; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Recurrence; Retrospective Studies; Risk Factors; Sclerosing Solutions; Treatment Outcome

We report a case of a 50-year-old man with a medical history of alcoholic cirrhosis, in addition to esophagogastric and duodenal varices (DV), who was transferred to our institution because of hemorrhagic DV. Emergent esophagogastroduodenoscopy showed hemorrhagic varices in the horizontal portion of the duodenum. Abdominal contrast-enhanced CT showed hemodynamics of DV derived from anastomosis between the superior mesenteric vein and right renal vein. Cyanoacrylate was injected into the DV. Subsequently, 5% ethanolamine-oleate was injected endoscopically as a sclerosant into the DV feeding vein. Radiographic fluoroscopic findings revealed that the injected cyanoacrylate and sclerosant remained, respectively, in the varices and its feeder. Five days later, CT showed that the injected cyanoacrylate occupied the DV, and thrombus formation of the afferent vein led to bifurcation of superior mesenteric vein. This case showed the usefulness of endoscopic injection sclerotherapy using cyanoacrylate and sclerosant for the management of DV.

Topics: Cyanoacrylates; Duodenum; Endoscopy, Digestive System; Gastrointestinal Hemorrhage; Hemodynamics; Humans; Male; Middle Aged; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Varicose Veins

Topics: Balloon Occlusion; Esophageal and Gastric Varices; Gastric Fundus; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Oleic Acids; Portasystemic Shunt, Transjugular Intrahepatic; Sclerosing Solutions

Balloon-occluded retrograde transvenous obliteration (B-RTO) is a new alternative treatment for gastric varices (GVx), but the long-term efficacy is not known. We investigated the long-term effects of B-RTO on rebleeding, prevention of first bleeding, mortality and occurrence of risky esophageal varices (EVx).. B-RTO was performed in 68 cirrhotic patients with GVx. Twenty patients had recent bleeding, transiently treated by endoscopic Histoacryl injection or balloon tamponade. Forty-eight patients had varices likely to bleed, but no bleeding. After B-RTO, the recurrent bleeding, occurrence of EVx and mortality over the long-term were evaluated.. B-RTO was successfully performed in 63 of 68 patients (92.6%). Varices eradication was confirmed by endoscopy in 61 of 63 patients (96.6%). During follow up, GVx bleeding occurred in two patients (3.2%). The 8-year cumulative rebleeding rates of patients with bleeding and risky GVx were 14% and 0%, respectively. Risky EVx occurred in 10 patients (17%) and the cumulative occurrence rate was 22% in 8 years. The cumulative occurrence rate of risky EVx was higher in GVx with EVx (GOV2-GVx) compared to GVx without EVx (IGV1, P < 0.05). No ectopic variceal bleeding occurred. No patients died from variceal bleeding. Hepatocellular carcinoma was the only significant prognostic factor (P < 0.05).. B-RTO is beneficial over the long-term, despite worsening EVx in some patients, because of excellent treatment efficacy and improved mortality. We believe that B-RTO can become a first-choice radical treatment following hemostasis for gastric variceal bleeding and prophylactic treatment for risky GVx.

Topics: Adult; Aged; Balloon Occlusion; Enbucrilate; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Gastroscopy; Hemostatic Techniques; Humans; Hypertension, Portal; Kaplan-Meier Estimate; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Phlebography; Recurrence; Risk Assessment; Sclerosing Solutions; Sclerotherapy; Time Factors; Tissue Adhesives; Treatment Outcome

We encountered a patient with a gastric varix that drained through the left inferior phrenic vein, which directly entered the inferior vena cava at the point just inferior to the diaphragm. In this patient, gastrorenal shunt was not seen. Balloon-occluded retrograde transvenous obliteration of the gastric varix was performed, in which 50% glucose and 5% ethanolamine oleate-iopamidol were injected as sclerosing agents while the balloon was inflated in the left inferior phrenic vein. 1 week after the procedure, the disappearance of enhancement in the gastric varix was confirmed on contrast-enhanced multidetector row CT. Furthermore, a significant reduction in the size of the varix was confirmed on endoscopic examination 4 months later.

Topics: Balloon Occlusion; Collateral Circulation; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hepatitis C, Chronic; Humans; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Radiography; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Vena Cava, Inferior

This is a prospective study, carried out in patients with portal hypertension and bleeding oesophageal varices secondary to Symmers (Schistosomal) periportal fibroses, to determine the efficacy of sclerotherapy, the number of sessions needed to achieve full sclerosis, the complications associated with sclerotherapy and the incidence and risk factors for rebleeding. In total, 85 patients were studied with a mean age of 38 years, 76.5% were males. All underwent upper gastrointestinal endoscopy, had different grades of oesophageal varices and underwent intravariceal injection with 5% ethanolamine oleate until they achieved full sclerosis or were referred to surgery. Complications of sclerotherapy included oesophageal strictures, deep oesophageal ulcers, pleural effusion and ascites. Following obliteration of oesophageal varices, 3.5% and 20% developed new gastric varices and portal gastropathy, respectively. Rebleeding occurred in 32% - the only significant predictive risk factor for which was patients with GIII varices following the first sclerotherapy session. Varices recurred in 6% of patients after a mean follow-up period of one year. In total, 93% of our patients achieved full sclerosis after an average of four sessions, and 3.5% were referred for surgery. Three patients (3.5%) died, all from massive rebleeding. In conclusion, sclerotherapy is a safe effective method for treating patients with oesophageal varices due to periportal fibroses.

Topics: Adult; Animals; Cross-Sectional Studies; Endoscopy; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Incidence; Male; Oleic Acids; Portal Vein; Prevalence; Prospective Studies; Recurrence; Schistosomiasis mansoni; Sclerosing Solutions; Sclerotherapy; Splenic Vein; Sudan

Topics: Enbucrilate; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostasis; Hemostatics; Humans; Injections; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Tissue Adhesives; Vasopressins

Many studies have suggested that endoscopic obliteration using cyanoacrylate for bleeding gastric fundal varices is effective. However, serious complications by injection of cyanoacrylate into varices have also been reported.. Thirty patients with bleeding gastric fundal varices underwent endoscopic injection sclerotherapy using 5% ethanolamine oleate under fluoroscopic guidance plus infusion of vasopressin and a transdermal nitroglycerin patch. The injection of 5% ethanolamine oleate was continued until it filled the varices and their feeder veins under fluoroscopic guidance. The injection needle was removed while thrombin glue was sprayed at the puncture site through the side hole of the injector needle to prevent bleeding from the puncture site.. Complete hemostasis was achieved in 28/30 patients (93.3%). The cumulative rebleeding rate after 1, 3 and 5 years was 13%, 19% and 19%, respectively. The 1-, 3-, and 5-year cumulative mortality rates were 31%, 54% and 59%, respectively. There was no complication related to infusion of vasopressin and sclerotherapy procedure.. The sclerotherapy method carried out using 5% ethanolamine oleate combined with infusion of vasopressin under fluoroscopic guidance might be a feasible method for obliteration of gastric fundal varices as an alternative to cyanoacrylate.

Topics: Adult; Aged; Cyanoacrylates; Esophageal and Gastric Varices; Feasibility Studies; Female; Gastric Fundus; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Hemostatics; Humans; Male; Middle Aged; Nitroglycerin; Oleic Acids; Recurrence; Sclerosing Solutions; Sclerotherapy; Survival Analysis; Treatment Outcome; Vasopressins

The safety and efficacy of poly-N-acetyl glucosamine (p-GlcNAc) gels were compared with standard agents in three different dog studies to assess abdominal venous collaterals, bleeding esophageal varices, and bleeding gastric varices.. Adult dogs with prehepatic portal hypertension and large abdominal venous collaterals, esophageal varices, or gastric varices were studied.. Significantly higher sclerosis rates were seen with F2 or F4 p-GlcNAc gels and standard sclerosants. F2 and F4 gels had high rates of permanent hemostasis, low rates of secondary ulceration, and significant reductions in esophageal and gastric variceal size. These results were either equivalent to or significantly better than the most commonly used gastric varix hemostatic agent (glue) or other sclerosing agents.. F2 and F4 poly-N-acetyl glucosamine gels are promising therapeutic agents for venous and variceal hemostasis.

Topics: Acetylglucosamine; Alcohols; Animals; Chemistry, Pharmaceutical; Disease Models, Animal; Dogs; Double-Blind Method; Drug Evaluation, Preclinical; Enbucrilate; Esophageal and Gastric Varices; Esophagoscopy; Gastrointestinal Hemorrhage; Gastroscopy; Gels; Hemostatic Techniques; Hemostatics; Hypertension, Portal; Oleic Acids; Random Allocation; Sclerosing Solutions; Sclerotherapy; Sodium Morrhuate; Wound Healing

Eradication of esophageal varices by repeated injection sclerotherapy and maintenance of eradication using continued surveillance endoscopy may reduce recurrent variceal bleeding and death from esophageal varices.. A prospective study of consecutive adult patients with endoscopically proved esophageal variceal bleeding.. A tertiary care university hospital in a metropolitan area.. Two hundred four patients (127 men and 77 women; mean age, 50.1 years; age range, 16-82 years) underwent 993 emergency and elective variceal endoscopic injection treatments with 5% ethanolamine oleate during 1992 endoscopy sessions. Most (166 [81.4%]) had cirrhosis, mainly due to alcohol abuse (131 [78. 9%]). The number of patients with each modified Pugh-Child risk grade was as follows: A, 30; B, 91; and C, 83. (The modified Pugh-Child classification comprises ascites, encephalopathy, serum albumin and bilirubin levels, and prothrombin time. Each variable is given a value of 1 to 3 with increasing impairment of liver function. Addition of the values leads to the Pugh-Child risk grades for each patient, with 5 and 6 giving grade A; 7 through 9, grade B; and 10 through 15, grade C, respectively.). Ninety-five patients (46.6%) rebled at a median of 17 days (range, 0-2583 days). Seventy-four patients (36.3%) had a total of 112 further bleeding episodes before eradication of varices. Varices were eradicated in 99 (87.6%) of 113 patients who survived longer than 3 months after a median of 5 injections and remained eradicated in 43 (mean follow-up after eradication, 38 months; range, 4-125 months). Rebleeding was markedly reduced after eradication of varices. Varices recurred in 56 patients, of whom only 10 rebled from recurrent esophageal varices. Cumulative survival by life table analysis was 55%, 41%, and 30% at 1, 3, and 5 years, respectively. One hundred thirty-seven patients (67.2%) died during follow-up. Liver failure was the most common cause of death. Minor complications (mucosal ulceration) occurred in 105 patients. Major complications, including a localized injection site leak (n = 9), esophageal stenosis (n = 25), and esophageal perforation (n = 5), occurred in 39 patients.. Repeated injection sclerotherapy eradicated esophageal varices in most long-term patients. Complications related to injection sclerotherapy were mostly minor. Complete eradication of varices reduced rebleeding and death from esophageal varices.

Topics: Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Life Tables; Male; Middle Aged; Oleic Acids; Prospective Studies; Recurrence; Retreatment; Sclerosing Solutions; Sclerotherapy; Survival Rate

Topics: Adolescent; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Male; Oleic Acids; Sclerosing Solutions; Sclerotherapy

Topics: Angiography; Catheterization; Collateral Circulation; Endoscopy, Digestive System; Esophageal and Gastric Varices; Follow-Up Studies; Gastric Fundus; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Oleic Acids; Renal Veins; Sclerosing Solutions; Sclerotherapy; Stomach

Emergency endoscopic injection sclerotherapy (EIS) has been applied to the initial treatment of gastric variceal bleeding and various methods have been attempted.. Emergency EIS was performed on 38 patients with gastric variceal bleeding using either the ethanolamine oleate (EO) method or n-butyl-2-cyanoacrylate (Histoacryl) method and the outcome was compared.. Complete haemostasis was defined as continuous haemostasis lasting for 14 days or more. Complete haemostasis was achieved in 52.4% of patients in the EO method versus 100% of those treated with the Histoacryl method, a significant difference, suggesting that the Histoacryl method was superior for achieving haemostasis in an emergency. The cumulative non-bleeding rate was also significantly higher in patients treated with Histoacryl, indicating the durability of haemostasis. There were no serious complications in patients who received either method of sclerotherapy. Post-EIS surgery was required in 42.8% of patients treated with EO, while no surgery was required in those treated with Histoacryl, supporting the greater haemostatic effect of Histoacryl. Although there was no significant difference in the cumulative survival rates of patients treated by these two methods, death from haemorrhage was avoided by using Histoacryl.. Based on these results, the Histoacryl method is thought to be the initial treatment of choice for gastric variceal bleeding, because it achieved superior haemostasis compared with EO and death by haemorrhage was avoided.

Topics: Emergencies; Enbucrilate; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Hepatitis C; Humans; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Retrospective Studies; Sclerosing Solutions; Survival Rate; Treatment Outcome

Topics: Catheterization; Duodenal Diseases; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Iopamidol; Jugular Veins; Middle Aged; Oleic Acids; Sclerosing Solutions

The pharmacologic response and microvascular effects associated with the endoscopic injection of sclerosing agents around vessels (paravascular injection) to stop bleeding from the digestive tract remain to be clarified.. Using in vivo microscopy, we directly visualized submucosal microvessels of the rat stomach and intestine. We studied differences among sclerosing agents in thrombus formation and vascular diameter change that occur through a pharmacologic response and/or local compression after topical application or paravascular injection of the agents.. Except for absolute ethanol, topical application of the agents did not cause constriction or thrombi in either arterioles or venules. Polidocanol topical application and paravascular injection significantly dilated arterioles. Injecting ethanolamine oleate near venules constricted them the longest and most effectively, but vasoconstriction in arterioles was transient. Injecting absolute ethanol formed long-lasting thrombi and caused vasoconstriction in venules, but arteriole thrombi persisted no more than 3 minutes. The vascular response to thrombin did not significantly differ from that to physiologic saline.. The paravascular injection of ethanolamine oleate, because of its long-lasting vasoconstriction, or of absolute ethanol, because of its thrombogenic effect, is a valid therapeutic approach to treating venous bleeding. The efficacy of paravascular injection of sclerosing agents for treating acute arterial bleeding, however, is not supported in this experimental model.

Topics: Animals; Digestive System; Ethanol; Gastrointestinal Hemorrhage; Injections; Male; Microcirculation; Oleic Acids; Polidocanol; Polyethylene Glycols; Rats; Rats, Wistar; Sclerosing Solutions; Sclerotherapy; Thrombin; Vasoconstriction; Vasodilation

Although less common than oesophageal varices in portal hypertension, gastric fundal varices carry a higher mortality rate when they rupture. They are less amenable to sclerotherapy. We have developed a minimally invasive balloon-occluded retrograde transverse obliteration (B-RTO) procedure to treat gastric fundal varices. B-RTO involves inserting a balloon catheter into an outflow shunt (gastric-renal or gastric-vena caval inferior) via the femoral or internal jugular vein. Blood flow is then blocked by inflating the balloon, and 5% ethanolamine oleate iopamidol is injected in a retrograde manner. The embolized gastric varix subsequently disappears. B-RTO was performed in 32 patients with gastric varices. Follow-up endoscopies were performed at intervals of 2-4 months for an average observation period of 14 months. Eradication of the varices has been confirmed in 31 of 32 patients. No recurrence occurred in any patients in the follow-up period. There were no significant changes in liver function after the procedure. We conclude that B-RTO is a safe and effective procedure for the treatment of gastric fundal varices.

Topics: Adult; Aged; Catheterization; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Male; Middle Aged; Oleic Acids; Radiography; Sclerosing Solutions; Sclerotherapy; Time Factors

After excluding terminally all patients, we evaluated a total of 718 patients treated with endoscopic injection sclerotherapy. They involved 350 episodes of acute hemorrhage and 368 prophylactic procedures in patients with risky varices. The 1-year cumulative survival rate was significantly lower in the acute hemorrhage group than in the prophylactic group (P < 0.05). The difference in survival between the two groups was primarily due to the number of deaths in the first 2 months after sclerotherapy (20.1% vs 0.8%, P < 0.0005). Improvements in the sclerotherapy technique significantly reduced the number of deaths from bleeding (9.3% vs 3.4%, P < 0.05), but not those from liver failure following variceal hemorrhage. Prophylactic EIS is advantageous in the treatment of esophageal varices, i.e. it may prevent deaths from liver failure attributed to variceal hemorrhages. The present study shows that preliminary prevention of variceal hemorrhage provides favorable hemostatic efficacy in patients with risky varices.

Topics: Cause of Death; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Liver Failure; Male; Middle Aged; Oleic Acids; Retrospective Studies; Sclerosing Solutions; Survival Rate; Time Factors; Treatment Outcome

Portal hemodynamics and transhepatic portal venographic findings were studied before and after prophylactic sclerotherapy (mean duration = 40 +/- 14 days) in 16 patients with high-risk esophageal varices. Portal pressure, evaluated by the portal venous pressure gradient, increased by a mean of 21% in eight patients (50%) and decreased by a mean of 20% in eight patients (50%) with no statistically significant change overall. The two groups were further analyzed separately to identify the mechanism of the change in portal pressure. Intrahepatic vascular resistance did not change significantly in either group. However, the prevalence of extravariceal portosystemic shunts was greater in patients with decreased portal pressure than in those with increased portal pressure (88% vs. 25%, p < 0.05). Further, the enlargement of extravariceal portosystemic shunts was more marked in patients with decreased portal pressure than in those with increased portal pressure (88% vs. 0%, p < 0.01). In addition, liver function, assessed by intrinsic clearance, was not modified in the two groups. We conclude that prophylactic sclerotherapy increases or decreases portal pressure without modifying liver function. Although the mechanism of these portal pressure changes is not clear, intrahepatic vascular resistance does not play an important role and the presence of extravariceal portosystemic shunts may prevent further increases in portal pressure.

Topics: Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Portal Pressure; Portal System; Prospective Studies; Sclerosing Solutions; Sclerotherapy

The authors report a 15-year experience with injection sclerotherapy in the management of adult and teenage patients with esophageal varices due to extrahepatic portal venous obstruction (EHPVO).. Extrahepatic portal venous obstruction is an uncommon cause of esophageal varices and is associated with normal liver function. Effective control of variceal bleeding is the major factor influencing survival. The results of surgery have been unsatisfactory, and therefore, more conservative management policies have been adopted.. Fifty-five patients with proven EHPVO underwent repeated injection sclerotherapy via either a modified rigid esophagoscope under general anaesthesia or a fiber-optic endoscope under light sedation, using ethanolamine oleate as the sclerosant.. Esophageal varices were eradicated in 44 patients after a median number 6 injections (range 1-17) over a mean of 12.5 months (range 1-48). The mean follow-up was 6.8 years (range 1.1-14.6 years). Eleven patients were admitted on eighteen occasions with bleeding from esophageal varices before eradication and there were seven bleeding episodes in six patients from recurrent varices after initial eradication. Complications related to sclerotherapy included injection site leak (6), stenosis (11) and mucosal ulceration (32) during 362 injection sclerotherapy episodes. Four patients died during the study period.. Injection scelotherapy is the treatment of choice in most patients with EHPVO.

Topics: Adult; Constriction, Pathologic; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Hypertension, Portal; Male; Oleic Acids; Portal Vein; Recurrence; Sclerosing Solutions; Sclerotherapy; Time Factors

The purpose of this study was to define the risk factors linked to the rupture of esophageal varices following endoscopic injection sclerotherapy. A total of 197 patients with esophageal varices who had been treated by endoscopic injection sclerotherapy between 1985 and 1991 were observed for post-therapeutic bleeding from esophageal varices. Among 197 patients, 96 had esophageal varices and concomitant hepatocellular carcinoma. Analysis by the multivariate Cox's proportional hazard model disclosed that incomplete eradication of esophageal varices, the presence of hepatocellular carcinoma, and Child-Pugh classes were statistically significant predictors for rupture of esophageal varices after sclerotherapy. We conclude that complete eradication of esophageal varices is essential for sustained effectiveness of endoscopic injection sclerotherapy. The presence of hepatocellular carcinoma and a lack of hepatic functional reserve, as indicated by Child's classification, are also major determinants of post-therapeutic bleeding.

Topics: Carcinoma, Hepatocellular; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Oleic Acids; Proportional Hazards Models; Risk Factors; Rupture, Spontaneous; Sclerosing Solutions; Sclerotherapy; Time Factors

To determine the factors predicting mortality from bleeding esophageal varices and to examine the possibility of an association between the development of adult respiratory distress syndrome (ARDS) and the use of ethanolamine oleate as an esophageal variceal sclerosant.. Retrospective review.. ICU in a teaching hospital.. A total of 101 patients with endoscopically confirmed bleeding esophageal varices were admitted on 124 occasions from 1985 to 1990. Mean age was 50 +/- 13.5 (SD) yrs. There were 62 males and 39 females. Using the Child-Pugh classification, 21.8% patients were class A, 38.6% class B, and 39.6% class C. Mean ICU and hospital lengths of stay were 5.4 +/- 5.1 and 19.6 +/- 16.1 days, respectively. Mean Acute Physiology and Chronic Health Evaluation (APACHE II) score on admission was 16.5 +/- 7.6.. Endoscopic variceal sclerotherapy was performed in 99 (79.8%) of 124 ICU admissions in the 101 patients. Esophageal balloon tamponade was performed in 64 (51.6%) and a vasopressin infusion was administered in 47 (37.9%) of the 124 ICU admissions. A variety of factors was studied to find predictors of mortality and the development of ARDS.. Forty-eight (48.5%) of the 101 patients died during the hospital stay. Independent predictors of mortality (by stepdown logistic regression) were total volume of ethanolamine oleate injected during sclerotherapy, multiple blood transfusions, Glasgow Coma Scale score, International normalized ratio for prothrombin test, and the presence of circulatory shock on ICU admission. Age, sex, Child-Pugh score, APACHE II score, serum bilirubin, albumin, and creatinine concentrations, use of esophageal balloon tamponade or vasopressin infusion, sepsis, pneumonia, congestive cardiac failure, aspiration, and ARDS were not statistically independent predictors of outcome. There was no difference in the mortality rates for the various causes of liver disease. Pulmonary complications occurred in 44 (43.6%) patients; sepsis occurred in 31 (25%) patients. ARDS developed in 14 patients (11.3% admissions, 13.9% patients). Statistically independent predictors of ARDS were sepsis, low plasma albumin concentration, use of esophageal balloon tamponade, and more than one sclerotherapy session. The volume and type of sclerosant used were not statistically independent predictors.. Outcome is poor for patients with bleeding esophageal varices requiring ICU admission and is related to the severity of liver failure, the degree of blood loss, and failure of therapy to stop the bleeding. The findings do not support an association between the use of the sclerosant ethanolamine and the development of ARDS.

Topics: Adult; Blood Transfusion; Critical Care; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Glasgow Coma Scale; Hospital Mortality; Hospitals, Teaching; Humans; Intensive Care Units; Length of Stay; Logistic Models; Male; Middle Aged; New South Wales; Oleic Acids; Predictive Value of Tests; Prognosis; Respiratory Distress Syndrome; Retrospective Studies; Severity of Illness Index; Shock, Cardiogenic; Treatment Outcome

Twenty-four patients, undergoing sclerotherapy for esophageal varices, were injected with 10-20 ml of ethanolamine oleate 5% in the first treatment session (group A). Fourteen patients were injected with 40 ml of the same sclerosant in the first session (group B). Retrospective analysis was carried out to evaluate the efficacy and safety of the two doses. Variceal eradication was achieved in group B in significantly fewer sclerotherapy sessions. Rebleeding occurred in 16% of patients in group A, compared with no rebleeding in group B. There was no significant difference in the incidence of various complications. We conclude that the use of 40 ml of 5% ethanolamine oleate in the first session is more effective and as safe as the use of 20 ml of the same sclerosant.

Topics: Adolescent; Adult; Aged; Child; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Recurrence; Retrospective Studies; Sclerosing Solutions; Sclerotherapy

We performed esophageal manometry on 17 cirrhotic patients (group I) treated with repeated varicose sclerosis (VS) after the varices had been completely eradicated. We used 5% ethanolamine oleate with the free hand technique, administering intra-varix injections at the cardia level, never exceeding 25 cc per session. The first two sessions were spaced a week apart, and the consecutive ones were on a monthly basis. The mean number of VS sessions was 5.52. The esophageal motility study was carried out on the average 12.3 months after the last VS session, with a minimum of six and maximum of 17 months. As controls we used 16 cirrhotic patients with unsclerosed varices (group II) and 26 healthy subjects (group III). The mean age and patient distribution were similar, according to Pugh grading. The length of the lower esophageal sphincter (LES) and the amplitude of the propulsive waves in the middle esophagus were similar in all three groups. We found the LES pressure to be significantly reduced in group I (17.52 +/- 2.8 mmHg) in relation to group II (20.26 +/- 2.49 mmHg) (p less than 0.001) and group III (22.86 +/- 3.73 mmHg) (p less than 0.01). The group II patients showed significantly lower pressure levels than the group III ones (p less than 0.05). The amplitude of peristaltic waves in the distal esophagus was significantly less in group I (22.94 +/- 7.31 mmHg) than in group II (37.46 +/- 10.95 mmHg) (p less than 0.01) and group III (44.8 +/- 11 mmHg) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Esophageal and Gastric Varices; Esophageal Motility Disorders; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Manometry; Middle Aged; Oleic Acids; Sclerosing Solutions; Sclerotherapy

Eighty cases of endoscopic injection sclerotherapy for esophageal varices were retrospectively studied to evaluate their prognoses. These cases were evaluated in terms of post-therapeutic bleeding, survival rates and causes of death. Post-therapeutic bleeding occurred in 50% of the emergency cases (26 cases), 25% of the elective cases (16 cases) and 23.7% of the prophylactic cases (38 cases). The frequency of post-therapeutic bleeding was significantly lower in cases with variceal obliteration than in cases without obliteration. An evaluation of the survival rates by the Kaplan-Meier method revealed that poor prognostic factors in sclerotherapy cases were emergency cases, Child's C group, post-therapeutic cases with unsuccessfully obliterated varices, and cases with post-therapeutic bleeding. Concerning early death within 7 days after sclerotherapy, 4 emergency cases died from initial variceal bleeding despite sclerotherapy. Three of these 4 were hepatocellular carcinoma cases, and all 3 cases had tumor thrombi of the portal vein. We recommend prophylactic sclerotherapy from the standpoint of the prognosis after sclerotherapy. However, in the bleeding cases of hepatocellular carcinoma in Child's C group complicated by tumor thrombi of the portal vein, overly enthusiastic application of the therapy should be avoided.

Topics: Actuarial Analysis; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Prognosis; Recurrence; Retrospective Studies; Sclerosing Solutions

Topics: Adult; Aged; Aged, 80 and over; Esophageal and Gastric Varices; Esophagoscopy; Evaluation Studies as Topic; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Sclerosing Solutions

Bleeding from oesophageal varices accounts for most of upper gastrointestinal bleeding in children (4). Repeat injection sclerotherapy proved to be a practical and effective method to control the bleeding and obliterate the varices (5, 8). This report describes a 13-year-old girl with portal hypertension who developed massive rectal variceal bleeding after repeat injection sclerotherapy of oesophageal varices.

Topics: Adolescent; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemorrhoids; Humans; Oleic Acids; Sclerosing Solutions

Topics: Adult; Esophageal and Gastric Varices; Esophagoscopy; Esophagus; Ethanolamines; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Oleic Acids; Sclerosing Solutions

Topics: Aged; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Oleic Acids; Rectum; Sclerosing Solutions; Varicose Veins

Topics: Esophageal and Gastric Varices; Esophageal Diseases; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Gastroscopy; Hematoma; Humans; Injections; Middle Aged; Oleic Acids; Sclerosing Solutions

Topics: Adult; Aged; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Prospective Studies; Sclerosing Solutions

Esophageal variceal sclerotherapy has been enthusiastically accepted as the procedure of choice for patients with variceal hemorrhage. Because the relationships among liver function, different causes of varices, survival, and rebleeding rates have not been well established in sclerotherapy trials, this enthusiasm may be unjustified. We studied these relationships in 80 patients with bleeding esophageal varices who were admitted to hospitals affiliated with our clinic between 1978 and 1980 and who did not receive sclerotherapy and in 162 patients admitted between 1980 and 1982 who received sclerotherapy with ethanolamine oleate. In both groups of patients, survival and bleeding-free intervals were significantly related (P less than 0.005 and P less than 0.01, respectively) to hepatic reserve (Child's class). In addition, patients with nonalcohol-related liver disease and poor hepatic reserve (Child's class C) had reduced survival and bleeding-free intervals compared with patients in class C with alcohol-related liver disease. Similar probabilities of survival and bleeding-free intervals were noted for Child's class subgroups and etiologic subgroups in the sclerotherapy and nonsclerotherapy groups, although a formal comparison was not made because of the retrospective nature of this study. Indications that sclerotherapy increases survival and reduces rebleeding may be due to different distributions of Child's classes and causes of varices within sclerotherapy and nonsclerotherapy groups in published control trials.

Topics: Esophageal and Gastric Varices; Esophagoscopy; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Liver Diseases; Liver Diseases, Alcoholic; Oleic Acids; Probability; Recurrence; Sclerosing Solutions; Time Factors

Topics: Adult; Aged; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Middle Aged; Oleic Acids; Sclerosing Solutions

Esophageal varices in 57 consecutive children were treated by injection sclerotherapy using 5% ethanolamine oleate injection via a fiberoptic endoscope (Olympus P2). Variceal obliteration was achieved with 4.7 and 5.7 injections in the extra- and intrahepatic disease groups. Complications of injections included hemorrhage, esophageal ulceration, and stricture. Thirty two cases were followed from 6 to 60 months after treatment and only five further bleeds were observed (extrahepatic 1: intrahepatic 4). The early results suggest that sclerotherapy is an effective method for the control of esophageal varices in children.

Topics: Adolescent; Child; Child, Preschool; Esophageal and Gastric Varices; Esophageal Diseases; Esophagoscopy; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Infant; Injections; Male; Oleic Acids; Sclerosing Solutions

Topics: Animals; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Oleic Acids; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sodium Morrhuate; Sodium Tetradecyl Sulfate

Topics: Adolescent; Adult; Aged; Endoscopy; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Sclerosing Solutions

Fifty-three patients with upper gastrointestinal bleeding and proven esophageal varices were treated by intravascular injection sclerotherapy of the varices using a mixture of ethanolamine oleate, bovine thrombin and cephalothin. An intraesophageal balloon was used to impede craniad flow during the injection. Except in three patients who failed to stop bleeding from nonvariceal lesions, sclerotherapy was 94 percent successful in controlling bleeding. The mortality rate in sclerotherapy patients with ascites was 25 percent compared with 54 to 75% reported elsewhere. There has been no rebleeding from varices after the third treatment week in patients followed up for up to 14 months.

Topics: Ascites; Endoscopy; Esophageal and Gastric Varices; Esophagogastric Junction; Ethanolamines; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Pilot Projects; Sclerosing Solutions

A routine upper gastrointestinal fiberoscope (Olympus GIFK) was used for endoscopic sclerotherapy of varices in 38 patients sedated with I.V. diazepam. It was effective in preventing rebleeding in 30 patients, and greatly reducing the size and number of varices in 31 of the patients. This endoscope needs no additional cuff or sheath for this therapy. It is easier to use and safer than the rigid oesophagoscope. Sodium tetradecyl sulphate is as effective as ethanolamine oleate as a sclerosant and causes no chest pain. Four patients developed a fibrotic lower oesophageal stricture. One patient developed an intramural haematoma that was followed by bacteraemia and death.

Topics: Adolescent; Adult; Aged; Endoscopy; Esophageal and Gastric Varices; Female; Fiber Optic Technology; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Prospective Studies; Recurrence; Sclerosing Solutions; Sodium Tetradecyl Sulfate; Stomach; Varicose Veins

From October 1977 to September 1981, 68 patients with esophageal varices (30 emergency cases of bleeding and 38 elective cases) were treated by injecting 5% ethanolamine oleate into varices, using an esophagofiberscope. Esophageal bleeding was successfully controlled in 29 of 30 patients who had emergency surgery. None of the 38 patients who underwent elective operation had bleeding after treatment. When recurrence occurred 1 or 2 years after treatment, the same procedure was repeated. Pleuritis occurred in one of the patients who had emergency surgery, and bleeding (300 to 400 ml) from the esophagocardial junction occurred in two patients who underwent elective operation. These patients were treatment conservatively.

Topics: Adult; Endoscopy; Esophageal and Gastric Varices; Female; Fiber Optic Technology; Gastrointestinal Hemorrhage; Humans; Male; Methods; Middle Aged; Needles; Oleic Acids; Radiography; Sclerosing Solutions

Topics: Adult; Esophageal and Gastric Varices; Esophagoscopes; Ethanolamines; Fiber Optic Technology; Gastrointestinal Hemorrhage; Humans; Middle Aged; Oleic Acids; Sclerosing Solutions