polidocanol and Emergencies

Although endoscopic injection therapy is effective in controlling initial haemorrhage from peptic ulcer, between 10% to 30% of patients suffer rebleeding.. To assess the factors that may predict the failure of endoscopic injection in patients bleeding from high risk gastric ulcer.. One hundred and seventy eight patients admitted for a gastric ulcer with a bleeding or a non-bleeding visible vessel were included.. Patients received endoscopic therapy by injection for adrenaline and polidocanol. Twelve clinical and endoscopic variables were entered into a multivariate logistic regression model to ascertain their significance as predictive factor of therapeutic failure.. Eighty seven per cent (155 of 178) of patients had no further bleeding after endoscopic therapy. Endoscopic injection failed in 23 (13%) patients: 20 (12%) continued to bleed or rebleed, and three (1%) patients could not be treated because of inaccessibility of the lesion. Logistic regression analysis showed that therapeutic failure was significantly related to: (1) the presence of hypovolaemic shock (p = 0.09, OR 2.38, 95% CI: 0.86, 6.56), (2) the presence of active bleeding at endoscopy (p = 0.02, OR 2.98, 95% CI: 1.12, 7.91), (3) ulcer location high on the lesser curvature (p = 0.04, OR 2.79, 95% CI: 1.01, 7.69), and (4) ulcer size larger than 2 cm (p = 0.01, OR 3.64, 95% CI: 1.34, 9.89).. These variables may enable identification of those patients bleeding from gastric ulcer who would not benefit from injection therapy.

Topics: Aged; Emergencies; Endoscopy, Gastrointestinal; Epinephrine; Female; Humans; Male; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Regression Analysis; Risk Factors; Sclerosing Solutions; Shock; Stomach Ulcer; Treatment Outcome; Vasoconstrictor Agents

In this study the frequency of rare causes of acute upper gastrointestinal bleeding was studied retrospectively using the case load of a large teaching hospital. Nine hundred and eighty patients with a clinical diagnosis of upper gastrointestinal bleeding were endoscoped between November 1987 and February 1993. Of these, 156 patients were found to be actively bleeding or had a visible vessel. Rare causes of bleeding were identified in 11 patients (7%). A Dieulafoy ulcer was found in five cases, and a mesenchymal tumor of the stomach in three patients. In the three remaining patients a bleeding gastric polyp, hemobilia and ischemic necrosis of the small bowel were identified as the source of bleeding. In three of these 11 patients the diagnosis was delayed and only made on repeat endoscopy the following day. Therapeutic endoscopy with circumlesional injection of epinephrine was successful in the majority of patients, and only three patients underwent emergency surgery. Two patients died during the acute bleeding episode, one of them had a Dieulafoy ulcer, the other suffered from ischemic bowel necrosis. Diagnosis of rare causes of acute upper gastrointestinal bleeding may be delayed, morbidity and mortality increased. Familiarity with these conditions may improve the outcome.

Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Duodenal Ulcer; Emergencies; Endoscopy, Digestive System; Epinephrine; Female; Gastrointestinal Hemorrhage; Humans; Male; Mallory-Weiss Syndrome; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Retrospective Studies; Stomach Ulcer; Survival Rate; Tissue Adhesives; Treatment Outcome

71 consecutive babies and children with bleeding esophageal varices managed primarily by emergency or elective paravariceal endoscopic sclerotherapy (PES) have been reviewed and followed up for twenty years. In 36 of them 53 different operations to prevent further variceal hemorrhage had been performed without permanent success. In 50 children (70 per cent--Group Ia), portal vein obstruction, in 2 (3 per cent--Group Ib), congenital hepatic fibrosis and in 19 (27 per cent--Group II) babies and children different types of cirrhoses were the cause of portal hypertension. Emergency PES was necessary for 29 and successful for 28 children (96.5 per cent). Recurrent bleeding in one child stopped after introduction and inflation of the Sengstaken-Blakemore tube. In one case an urgent transthoracic esophageal resection and fundoplication was performed because of recurrent hemorrhage in spite of repeated PES. 6 children--3 foreigners--were lost to follow-up after 3, 5, 6, 7, 11 and 12 years. Under regular PES there were 3 rebleedings (4 per cent) during the first month managed successfully by PES or conservatively; another 3 rebleedings (4 per cent) occurred during the first year. In "sclerotherapy failures" (recurrent hemorrhage in spite of chronic PES in 6 children aged more than 10 years 6 elective and selective shunts were carried out 3, 5, 6, 8, 10 and eleven years after the first PES. The number of complications was high, but the vast majority was asymptomatic and no complications was responsible for death. There was no death in children with portal vein obstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Child; Child, Preschool; Emergencies; Esophageal and Gastric Varices; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Hypertension, Portal; Infant; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Failure

Topics: Adult; Aged; Aged, 80 and over; Emergencies; Esophageal and Gastric Varices; Esophagoscopes; Female; Fiber Optic Technology; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Sclerotherapy

From January 1982 to January 1987, a prospective, nonrandomized sclerotherapy study was conducted at the Heinz-Kalk Hospital, Bad Kissingen, with 232 consecutive patients receiving immediate endoscopic injection sclerosis (IEIS) for variceal bleeding during emergency endoscopy. No patient was excluded from this study. All patients were classified according to the Child-Pugh criteria: 53 (23%) were in category A; 70 (30%) in category B; and 109 (47%) in category C. More than 93% had liver cirrhosis, 60% of alcoholic origin. IEIS was performed during emergency fiberoptic endoscopy applying 5-40 1-ml injections of 0.5% polidocanol by the paravariceal, "free" injection technique. If this was not successful, an intravariceal approach was used, and after 15 min of injection and persisting hemorrhage a Linton-Nachlas tube was inserted for 6-12 h. If hemorrhaging recurred, a second emergency endoscopy with IEIS was performed and, if this was not successful, a gastroesophageal disconnection followed directly. During the bleeding-free interval, Child-Pugh A and B patients were selected, using special criteria, for a shunt operation. An elective, semiselective, or selective shunt was recommended and carried out. In 56 patients (24%), a gastroesophageal disconnection or a shunt operation was performed on an emergency or elective basis. All sclerotherapy patients were controlled after 4 months and thereafter every 6, 9, or 12 months and reinjected if necessary. Bleeding was controlled in 93% of the cases with IEIS, and, in 97%, with a combination of IEIS and Linton-Nachlas tube. Definitive control of hemorrhaging was accomplished in 94% of the patients. Thirty-five patients died during the first 30 days of admission (15.1%).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Actuarial Analysis; Emergencies; Endoscopy; Esophageal and Gastric Varices; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Time Factors

The authors present their experience of endoscopic sclerosis of esophageal varices in 56 patients in a period of about two and half year (February '83-July '85). 46% of the patients were of the group C according to Child's criteria and 48.2% showed a fourth degree varices according to Paquet's criteria. Twenty-nine patients (51.7%) were submitted to the sclerosis as emergency treatment, 17 patients (30.3%) had an elective procedure and 10 (17.8%) were treated by a prophylactic sclerosis. The hemorrhage was stopped in 25 cases (86%) among emergency treated patients. However a new hemorrhage was observed before the end of the cycle of treatment in 48%. On the contrary 17% of patients complained recurrent hemorrhage after completing the treatment. Thirty-five per cent of patients electively treated showed recurrent hemorrhage while 40% bled after prophylactic treatment. Thirty-eight patients had a follow up of one year with results very similar to these reported in the literature. As a conclusion, on the bases of the reported results the authors suggest to submit to this treatment all the patients with recent hemorrhage or in emergency. The sclerosis should be reserved as elective procedure only to the patients of the class C; class A should be reserved to surgery while patients of the class B are matter of debate. Moreover prophylactic treatment, theoretically very attractive, needs further evaluation, at least in their hand.

Topics: Adult; Aged; Emergencies; Esophageal and Gastric Varices; Esophagoscopy; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions

By using the literature important facts of the spontaneous course of ulcer bleeding are presented. Patient groups with a high risk for early rebleeding are characterized. The indication for operation is discussed regarding intensity and activity of bleeding and endoscopic findings. The operative technique of haemostasis in duodenal and gastric ulcer is described. The own cases are analysed with special respect to endoscopic haemostasis.

Topics: Adult; Aged; Arteries; Duodenal Ulcer; Duodenum; Emergencies; Endoscopy; Humans; Laser Therapy; Ligation; Middle Aged; Peptic Ulcer; Peptic Ulcer Hemorrhage; Peptic Ulcer Perforation; Polidocanol; Polyethylene Glycols; Prognosis; Recurrence; Stomach Ulcer; Suture Techniques

The data of 19 consecutive unselected patients undergoing emergency sclerotherapy who were admitted to a single intensive care unit throughout the course of one year, were analyzed retrospectively for clinical and bacteriological signs of septicemia after the first sclerotherapy session. Ten had fever and/or chills, and in six of these patients microorganisms were cultured from arterial blood or central venous catheter tips. The data show that about one-third of patients with liver cirrhosis and acute variceal hemorrhage undergoing emergency sclerotherapy may develop septic disease.

Topics: Adult; Aged; Cross Infection; Emergencies; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Injections; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sepsis

Endoscopic injection of polidocanol was used in a prospective study of 88 patients with gastroduodenal bleeding. Active bleeding by injecting polidocanol (1%) in 54 patients achieved initial haemostasis in 51 (94%); lasting arrest of bleeding was achieved in 39 (72%). This injection treatment was also used to prevent recurrence of bleeding where there had been signs of previous bleeding: this proved successful in 25 of 34 patients (74%). The endoscopic injection method thus gave results equivalent to other endoscopic methods of achieving haemostasis.

Topics: Emergencies; Endoscopy; Gastrointestinal Hemorrhage; Humans; Injections; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies

In a prospective study a new therapeutic concept was tested on 76 patients with bleeding gastroduodenal ulcers. During emergency endoscopic an exact inspection of the ulcercrater helped to determine the possibility of recurrent bleeding of the ulcer. This possibility was expressed in a modified Forrest-classification. Endoscopic hemostasis has been performed in all cases of active bleeding. Ulcers with a big visible vessel stump should be operated early elective after an intervall of intensive care, because definitive endoscopic hemostasis seemed not to be sufficient with this bleeding type. The new concept decreased the operation frequency of bleeding gastroduodenal ulcers from 51% in 1981/82 to 34% in 1983. Mortality of bleeding duodenal ulcers decreased from 18% to 8,6%, in bleeding stomach ulcers from 24% to 18%. Endoscopic hemostasis with injection therapy has proved to be most successfull in the F1b bleeding type.

Topics: Aged; Combined Modality Therapy; Emergencies; Gastrectomy; Gastroscopy; Humans; Middle Aged; Peptic Ulcer; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prognosis; Recurrence; Therapeutic Irrigation