polidocanol and Esophageal-Stenosis

To compare endoscopic variceal ligation (EVL) with a combination of EVL and endoscopic scelerotherapy (EST) in the secondary prophylaxis of esophageal variceal bleeding.. Fifty patients with esophageal varices due to cirrhosis of the liver (38), noncirrhotic portal fibrosis (7), or extrahepatic portal venous obstruction (5) were included in the study. These 50 patients were randomized to receive either EVL alone or a combination of EVL and EST for variceal eradication. Twenty-one patients received EVL alone (group A), and 23 patients received EVL and EST (group B). In group B, EVLs were performed until the varices were reduced to grade II size, and, subsequently, these patients underwent low-dose sclerotherapy with 1% polidocanol until variceal eradication was achieved.. Combined EVL and EST treatment eradicated the varices in a significantly greater number of patients then EVL alone (87% vs. 24%; p < 0.05). However, significantly more endoscopic sessions were required with combined treatment than with EVL alone (5.87 +/- 2.32 vs. 4.28 +/- 1.82; p < 0.05). Rebleeding episodes before variceal eradication were similar in the two groups (19% vs. 22%). The complications were similar in both the EVL and the EVL-plus-EST group, ie., deep ulcers (16% vs. 20%), transient dysphagia (20% vs. 32%), and stricture (4% vs. 8%).. Thus, combined EVL and EST treatment eradicates varices in a significantly larger number of patients than EVL alone, with no extra complications.

Topics: Adult; Combined Modality Therapy; Deglutition Disorders; Esophageal and Gastric Varices; Esophageal Stenosis; Esophagoscopy; Female; Fibrosis; Gastrointestinal Hemorrhage; Humans; Ligation; Liver Cirrhosis; Male; Peripheral Vascular Diseases; Polidocanol; Polyethylene Glycols; Portal Vein; Prospective Studies; Recurrence; Remission Induction; Sclerosing Solutions; Sclerotherapy; Ulcer

Human epidermal growth factor (EGF), a small polypeptide (6 kDa) with mitogenic properties, has been implicated in the protection of gastrointestinal mucosal integrity. The efficacy of EGF in the prevention and healing of sclerotherapy-induced esophageal lesions was investigated in 24 minipigs with surgically induced portal hypertension. In addition, the effect of EGF on intragastric acidity and pharmacokinetics was investigated as possible means to explain its protective mechanism of action. The animals underwent three weekly sessions of sclerotherapy with polidocanol 2% and were concomitantly and for an additional three weeks treated with either placebo or EGF administered paravenously in the esophagus and/or subcutaneously. The subcutaneous treatment with EGF significantly (P < 0.05) reduced esophageal stricture and scar formations associated with sclerotherapy. Gastric pH values were significantly (P < 0.01) elevated only in animals receiving subcutaneous injections of EGF. Furthermore, the subcutaneous administration of EGF was associated with unexpected prolonged plasma concentration of the peptide. These results suggest a possible clinical value of EGF as an adjunctive treatment with the sclerotherapy.

Topics: Animals; Epidermal Growth Factor; Esophageal Diseases; Esophageal Stenosis; Gastric Juice; Humans; Hydrogen-Ion Concentration; Male; Polidocanol; Polyethylene Glycols; Recombinant Proteins; Sclerosing Solutions; Sclerotherapy; Swine; Swine, Miniature; Ulcer

Topics: Esophageal and Gastric Varices; Esophageal Stenosis; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Time Factors

Topics: Esophageal and Gastric Varices; Esophageal Stenosis; Humans; Omeprazole; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Ulcer

Topics: Aged; Constriction, Pathologic; Esophageal Stenosis; Female; Gastrointestinal Neoplasms; Humans; Male; Palliative Care; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Nowadays injection treatment is not only used for sclerosing esophageal varices but also for stopping hemorrhage from mucosal lesions. This method is equally effective for treatment of hemorrhages after polypectomies and papillotomies. New indications for this method are benign and malignant stenoses of the esophagus. Good results in sclerosing of varices and of stopping hemorrhage have been confirmed very often; however further experience is needed in the treatment of stenoses.

Topics: Ampulla of Vater; Common Bile Duct Diseases; Endoscopy; Esophageal and Gastric Varices; Esophageal Neoplasms; Esophageal Stenosis; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Injections; Intestinal Polyps; Palliative Care; Polidocanol; Polyethylene Glycols; Postoperative Complications; Sclerosing Solutions

Topics: Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Humans; Injections; Polidocanol; Polyethylene Glycols

Oesophageal stricture and dysphagia after endoscopic sclerotherapy of oesophageal varices were assessed with regard to occurrence and severity and the relation to the treatment. We followed 34 patients for three to 47 months who had two to 25 treatments with submucosal, paravenous injections of polidocanol (3%). Twenty patients (59%) developed stricture or dysphagia; 14 both dysphagia and endoscopically verified stricture, two dysphagia without stricture, and four stricture without dysphagia. Both phenomena occurred intermittently and often independent of each other, but occupied median 38% of the observation time in these 20 patients. The patients developing strictures had received significantly more treatments and greater amount of sclerosant, and they had significantly more preceding mucosal necroses. The varices were eradicated to about the same degree and the incidence of recurrent haemorrhage was the same as in the patients who had not developed stricture.

Topics: Adolescent; Adult; Aged; Deglutition Disorders; Endoscopy; Esophageal and Gastric Varices; Esophageal Stenosis; Gastrointestinal Hemorrhage; Humans; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions