polidocanol and Esophageal-and-Gastric-Varices

Gastric varices (GVs) are a major complication of portal hypertension in patients with liver cirrhosis. The mortality rate associated with the bleeding from GVs is not low. Balloon-occluded retrograde transvenous obliteration (BRTO) was first introduced by Kanagawa et al. as a treatment for isolated GVs in 1994. It has been performed most frequently in Asia, especially in Japan. Ethanolamine oleate was the original sclerosant used in the therapy. Since the late 2000s, BRTO using sodium tetradecyl sulfate foam or polidocanol foam as a sclerosant has been performed in many countries other than Japan. Then, early in the 2010s, modified BRTO techniques including vascular plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration were developed as an alternative treatment for GVs. This article provides a historical overview of BRTO using various sclerosants and modified BRTO techniques, such as plug-assisted retrograde transvenous obliteration and coil-assisted retrograde transvenous obliteration.

Topics: Balloon Occlusion; Esophageal and Gastric Varices; Humans; Hypertension, Portal; Liver Cirrhosis; Oleic Acids; Polidocanol; Sclerosing Solutions; Sodium Tetradecyl Sulfate

To compare the efficacy and safety of the modified sandwich method with lauromacrogol in the treatment of gastric variceal bleeding (GVB) caused by liver cirrhosis with the traditional sandwich method no accompanied by lauromacrogol via a meta-analysis.. The Cochrane Library, Pubmed, the China National Knowledge Infrastructure (CNKI) database, the Chinese Wanfang database, and the Chongqing VIP database were searched to identify cohort studies comparing modified to traditional sandwich method in the treatment of GVB with liver cirrhosis. The relative risk for hemostasis rate, gastric varices (GV) remission rate, re-bleeding rate, the incidence of post-operative complications (pain, fever, ulcer or erosion, ectopic embolism), and all-cause mortality were calculated. The mean difference for average tissue adhesive dosage per case was calculated. Relevant data were analyzed with the Reviewer Manager 5.3.5.. Four cohort studies with a total of 587 patients were included in this meta-analysis. In the treatment of GVB with liver cirrhosis, compared with the traditional sandwich method, the modified sandwich method was associated with a higher GV remission rate (RR: 1.24, 95% CI: 1.09-1.42; P = .001) according to the pooled results. There were no statistically significant differences between the 2 methods in the rate of hemostasis, re-bleeding, pain, fever, ulcer or erosion, ectopic embolism, and all-cause mortality (P ≧ .05).. This meta-analysis indicated that the modified sandwich method with lauromacrogol is more effective than the traditional sandwich method without lauromacrogol. Due to the limited number of studies and samples, more RCT studies are needed to further validate the efficacy and safety of the modified sandwich method with lauromacrogol in the treatment of GVB with liver cirrhosis.

Topics: Esophageal and Gastric Varices; Hemorrhage; Humans; Liver Cirrhosis; Polidocanol; Sclerosing Solutions; Sclerotherapy; Tissue Adhesives

Polidocanol is approved for its competence in the treatment of varicose veins and spider veins; however, unfortunately, many of its off-label uses are still underappreciated.. Lack of an appropriate comprehensive review for off-label uses of this medication troubles physicians about making evidence-based decisions on prescribing it for its various outstanding off-label uses. This article attempts to provide physicians with the latest information concerning successful and unsuccessful use of polidocanol as an alternative treatment for esophageal and gastric varices, tendinopathy and epicondylitis, vascular malformations, varicocele, hydrocele and spermatocele, aneurysmal bone cysts, itching, management of gastrointestinal bleeding, simple renal cysts, reducing the incidence and severity of radio-induced dermatitis and hemorrhoids.. The two databases of MEDLINE and Cochrane Library were searched for all human English studies, published in January 2006 to November 2017, which contained the keyword of "polidocanol" or its alternative MeSH terms.. Our search identified a total number of 597 articles. Those articles that were only discussing the approved uses of polidocanol were excluded and the remaining 116 articles were reviewed. Eleven major and 30 minor off-label uses were found within included studies.. Numerous successful administrations of this drug in a variety of clinical conditions lead to promising perspectives toward it. Sclerotherapy with polidocanol as a minimal-invasive method (having similar outcomes like the prevalent surgeries) may reduce the rate of complications. Furthermore, for determining the most appropriate method and dosage, randomized clinical trials are needed, confirming and providing more clear instructions for different conditions.

Topics: Drug Approval; Esophageal and Gastric Varices; Evidence-Based Medicine; Humans; Off-Label Use; Polidocanol; Sclerosing Solutions; Sclerotherapy

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

Topics: Contraindications; Cyanoacrylates; Endosonography; Esophageal and Gastric Varices; Esophagoscopy; Gastroscopy; Humans; Ligation; Oleic Acids; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

A number of randomized clinical trials of prophylactic sclerotherapy have been carried out with different results. The main objective of this study was to determine if the literature provides evidence that prophylactic sclerotherapy increases the survival rate of patients with esophageal varices.. Meta-analysis was used to evaluate the effect of prophylactic sclerotherapy on the survival of patients with esophageal varices. Only randomized controlled trials that compared prophylactic sclerotherapy to placebo were included.. Fourteen fully published randomized controlled trials, as well as six trials published as abstracts, were identified in the English literature. Pooling of the 14 fully published trials yielded an odds ratio of death in the treatment group compared with the control group of 0.74 (95% confidence interval, 0.60-0.93) in favor of prophylactic sclerotherapy. There was statistically significant heterogeneity that resolved when the trials were pooled in subgroups based on the sclerosant used. Pooling of trials using polidocanol showed a highly significant benefit for prophylactic sclerotherapy in terms of overall mortality, particularly when those trials that selected subjects at high risk of bleeding were pooled, yielding an odds ratio of 0.51 (95% confidence interval, 0.36-0.73). When trials using sodium tetradecyl sulfate were pooled, a detrimental effect for prophylactic sclerotherapy was seen, with an odds ratio of 1.86 (95% confidence interval, 1.15-3.00). Subgroup analysis by Child's class showed no benefit for patients in Child's class A.. These results suggest that prophylactic sclerotherapy with polidocanol is effective, particularly in high-risk patients.

Topics: Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Odds Ratio; Polidocanol; Polyethylene Glycols; Publication Bias; Risk Factors; Sclerosing Solutions; Sclerotherapy; Sodium Tetradecyl Sulfate; Treatment Outcome

We report the case of a 52-years-old smoking male, diagnosed of liver cirrhosis, who developed a squamous cell carcinoma of the esophagus 36 months after undergoing endoscopic injection sclerotherapy for bleeding esophageal varices. Nine courses with 3% polidocanol were performed along 10 months. It was injected intra and paravariceal at a total dose of 117 ml. The relationship between endoscopic injection sclerotherapy and developing squamous cell carcinoma of the esophagus is discussed.

Topics: Carcinoma, Squamous Cell; Esophageal and Gastric Varices; Esophageal Neoplasms; Esophagoscopy; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Time Factors

Topics: Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Concerned by mortality due to recurrent bleeding and associated risk factors in cirrhotic patients, we attempted to compare the efficiency of perivascular sclerotherapy using quinine urea with that of intravascular polidocanol and to determine the predictive factors of clinical outcome. Of 74 patients admitted for bleeding esophageal varices, 31 were treated with perivascular sclerotherapy (group I), and 43 with intravascular sclerotherapy (group II). Three months later, only 63 p. 100 of patients in group I had not rebled, compared to 90 p. 100 of patients in group II (p less than 0.001). After 6 months, no significative difference was found between the two groups. The one year survival rate was 44 p. 100 in group I and 79 p. 100 in group II (p less than 0.002). Encephalopathy and ascites were found to be predictive factors of mortality, whereas neither clinical or biologic factors were found to be predictive for recurrent bleeding. These results suggest that in esophageal sclerotherapy, the intravascular route with polidocanol provides earlier results and a better one year survival rate, compared with the perivascular route. However, survival rates depend on encephalopathy and ascites criteria.

Topics: Drug Combinations; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Quinine; Recurrence; Retrospective Studies; Risk Factors; Sclerosing Solutions; Urea

Herein, our group designed a novel technology, termed balloon compression-assisted endoscopic injection sclerotherapy (bc-EIS), which was applied to improve the efficiency of eradicating esophageal varices (EVs). The present study aimed to compare the rate of eradication and efficacy between bc-EIS and endoscopic variceal ligation (EVL) in the management of EVs.. Ninety-five patients with esophageal variceal bleeding (EVB) were randomly assigned to receive bc-EIS or ligation alone. Additional treatment sessions were held 1 month later and then at 3-month intervals until eradication of the varices was achieved. Endoscopic follow-up examinations were carried out at 6-month intervals in the absence of recurrence or immediately if there was any recurrent bleeding.. The mean physical injection points per session were 2.89 ± 0.79, and the mean volume of lauromacrogol used per session was 17.74 ± 7.09 ml in the bc-EIS group. The mean band per session was 6.13 ± 0.86. The rate of eradication after one to three rounds of bc-EIS was obviously higher than that of the EVL group (89.36%, 97.87%, and 100% vs. 37.5%, 43.75%, and 47.92%, respectively). Retrosternal pain or discomfort in the bc-EIS group was slightly lower than that in the EVL group (23.4%, 11/47 vs. 31.25%, 15/48). Two and five patients showed mild abdominal bloating and distension between the bc-EIS and EVL groups, respectively (2/47, 4.26% vs. 5/48, 10.42% P > 0.05). Nausea and vomiting were reported in one patient (1/47, 2.13%) in the bc-EIS group and three patients (3/48, 6.25%) in the EVL group. However, there were no statistically significant differences between the two groups (P > 0.05). No fatal or severe complications, such as esophageal perforation, esophageal stricture or ectopic embolism, were observed.. The bc-EIS method was effective in eradicating EVs and was accompanied by fewer complications.

Topics: Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Ligation; Polidocanol; Prospective Studies; Recurrence; Sclerotherapy

Endoscopic treatment is widely accepted as the first-line therapy selection for esophageal variceal bleeding. Nevertheless, endoscopic injection sclerotherapy requires experienced endoscopists and is associated with a high risk of bleeding. Our study evaluates the feasibility and efficacy of transparent cap-assisted endoscopic sclerotherapy in the management of esophageal varices.. A randomized-controlled trial was conducted in a tertiary referral center from April 2015 to May 2016. Patients who received endoscopic sclerotherapy were randomized in a blinded manner into two groups: the transparent cap-assisted group (n=59) and the control group (n=61).. The average injection sites were reduced in the transparent cap-assisted group compared with the control group (1.2±0.4 vs. 1.4±0.05, P=0.000), whereas no difference was observed in the dosage of lauromacrogol (16.97±4.91 vs. 16.85±4.57, P=0.662) and the hemorrhage that occurred during injection made no difference (50.8 vs. 61.0%, P=0.276); yet, salvage hemostasis methods were used in only nine patients in the transparent cap-assisted group compared with 17 patients in the control group (25.0 vs. 38.7%, P=0.0936). The cost of each procedure in the cap-assisted group was ¥2578 (1878-4202), whereas it was ¥3691 for the control group (2506-5791) (P=0.023). Moreover, in both groups, no esophageal constriction was observed during the 6-month follow-up period, whereas the rebleeding rate between two groups showed no statistical significance in 6 months (89.8 vs. 93.4%, P=0.563).. Transparent cap-assisted sclerotherapy provided a clear field of vision and helped to fix the targeted veins, thus significantly reducing the use of the salvage hemostasis method during sclerotherapy injection hemorrhage. It is also associated with reduced injection sites and endoscopic therapy cost.

Topics: China; Cost-Benefit Analysis; Equipment Design; Esophageal and Gastric Varices; Esophagoscopes; Esophagoscopy; Feasibility Studies; Female; Gastrointestinal Hemorrhage; Health Care Costs; Hemostasis, Endoscopic; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Sclerosing Solutions; Sclerotherapy; Tertiary Care Centers; Time Factors; Treatment Outcome

To investigate the efficacy and safety of a combination of sufentanil and propofol injection in patients undergoing endoscopic injection sclerotherapy (EIS) for esophageal varices (EVs).. Patients with severe EVs who underwent EIS with sufentanil and propofol anesthesia between April 2016 and July 2016 at our hospital were reviewed. Although EIS and sequential therapy were performed under endotracheal intubation, we only evaluated the efficacy and safety of anesthesia for the first EIS procedure. Patients were intravenously treated with 0.5-1 μg/kg sufentanil. Anesthesia was induced with 1-2 mg/kg propofol and maintained using 2-5 mg/kg per hour of propofol. Information, regarding age, sex, weight, American Association of Anesthesiologists (ASA) physical status, Child-Turcotte-Pugh (CTP) classification, indications, preanesthetic problems, endoscopic procedure, successful completion of the procedure, anesthesia time, recovery time, and anesthetic agents, was recorded. Adverse events, including hypotension, hypertension, bradycardia, and hypoxia, were also noted.. Propofol and sufentanil anesthesia was provided in 182 procedures involving 140 men and 42 women aged 56.1 ± 11.7 years (range, 25-83 years). The patients weighed 71.4 ± 10.7 kg (range, 45-95 kg) and had ASA physical status classifications of II (79 patients) or III (103 patients). Ninety-five patients had a CTP classification of A and 87 had a CTP classification of B. Intravenous anesthesia was successful in all cases. The mean anesthesia time was 33.1 ± 5.8 min. The mean recovery time was 12.3 ± 3.7 min. Hypotension occurred in two patients (1.1%, 2/182). No patient showed hypertension during the endoscopic therapy procedure. Bradycardia occurred in one patient (0.5%, 1/182), and hypoxia occurred in one patient (0.5%, 1/182). All complications were easily treated with no adverse sequelae. All endoscopic procedures were completed successfully.. The combined use of propofol and sufentanil injection in endotracheal intubation-assisted EIS for EVs is effective and safe.

Topics: Adult; Aged; Aged, 80 and over; Anesthesia; Anesthetics, Intravenous; Esophageal and Gastric Varices; Esophagoscopy; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Postoperative Complications; Propofol; Sclerotherapy; Sufentanil; Time Factors; Treatment Outcome

Current guidelines recommend injection of cyanoacrylate as first-line therapy to prevent gastric variceal rebleeding. The method still poses a risk of ectopic embolism, which possibly correlates with the volume of cyanoacrylate used. In this trial, we evaluated the short-term efficacy and safety of tissue adhesive injection combined with lauromacrogol for treating gastric varices.. Patients admitted to our hospital for variceal hemorrhage were enrolled and blindly randomized into two treatment groups: lauromacrogol group (lauromacrogol-cyanoacrylate-lauromacrogol) and lipiodol group (lipiodol-cyanoacrylate-lipiodol). Patient follow-up was 6 months. Primary outcome was rebleeds, and secondary outcomes were mortality, gastric varices eradication, and treatment-related adverse events.. Between March 6, 2013 and October 16, 2013, 96 patients met the criteria. Two cases were lost to follow-up, and all treated cases were successful. No procedural-related adverse events were observed in either group. Cyanoacrylate volumes used in the lauromacrogol group were significantly less than those of the lipiodol group (0.9 ± 0.5 vs 2.0 ± 1.2 mL, P = 0.000). Eleven patients developed upper gastrointestinal rebleeding, which did not show significant difference between groups. On multivaritate analysis, portal venous thrombosis and fever were potential risk factors of rebleeding. Treatment failure, complications, gastric varices obturation, and survival did not differ between the two groups.. Tissue adhesives combined with lauromacrogol is a safe therapeutic option for gastric varices, with comparably less cyanoacrylate volume used. Because of the small number of study patients, it cannot be proven to have better efficacy than without lauromacrogol. Multicenter studies with larger patient groups are necessary.

Topics: Adult; Aged; Cyanoacrylates; Drug Tolerance; Esophageal and Gastric Varices; Ethiodized Oil; Female; Fever; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Injections, Intralesional; Male; Middle Aged; Multivariate Analysis; Pilot Projects; Polidocanol; Polyethylene Glycols; Portal Vein; Recurrence; Risk Factors; Sclerosing Solutions; Tissue Adhesives; Venous Thrombosis

A recently published network meta-analysis showed that ligation combined with sclerotherapy might be the most efficacious intervention for secondary prophylaxis of variceal bleeding. Most studies excluded patients with concomitant gastric varices; thus, the outcomes in such patients have not yet been reported. The present study aimed to investigate the efficacy of two endoscopic procedures for secondary prophylaxis in cirrhotic patients presenting with both esophageal and gastric varices.. A randomized controlled study was carried out in a tertiary care referral center. Patients were randomized into two groups: sclerotherapy- and sclerotherapy+ group. Continued endoscopic ligation was used to treat esophageal varices in the sclerotherapy- group, whereas combined ligation and sclerotherapy with lauromacrogol was performed in the sclerotherapy+ group. A cyanoacrylate injection was used for gastric varices in both groups. All participants were followed up for 6 months.. Overall, 96 patients were included between 25 March 2012 and 25 June 2013. Three patients were lost during follow-up (one in the sclerotherapy- group and two in the sclerotherapy+ group). The cumulative recurrence rate of bleeding was significantly higher in the sclerotherapy+ group (14.6 vs. 35.4%, P=0.013). The cumulative mortality rate (2.1 vs. 6.3%, P=0.286) and the incidence rate of adverse events were similar between the two groups.. Continued ligation+cyanoacrylate injection was superior to combined ligation and sclerotherapy+cyanoacrylate injection during the first 6 months in terms of rebleeding in cirrhotic patients presenting with both esophageal and gastric varices. Long-term results entail further investigation (http://www.clinicaltrials.gov, NCT01592578).

Topics: Adult; Aged; Combined Modality Therapy; Cyanoacrylates; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Ligation; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Sclerotherapy; Survival Rate

Variceal bleeding is a medical emergency with 20% mortality at 6 weeks. The role of vasoactive agents in achieving hemostasis and preventing rebleeding has been well documented. The optimal duration of these agents has not been well established. There are no previous studies yielding the exact duration of octreotide to be administered to prevent rebleed and mortality from esophageal varices. The aim of this study is to evaluate the effect of combination therapy (octreotide and endoscopy), the exact duration of octreotide infusion, its cost-effectiveness, and the outcome in terms of rebleed and mortality.. This was a randomized clinical trial including 124 patients with acute variceal bleeding who underwent endoscopic therapy; they were assigned randomly to 2 days (n=62) and 5 days (n=58) of continuous octreotide infusion (50 μg/kg). Early rebleeding (within 42 days of index bleed according to Baveno IV consensus guidelines), transfusion requirement, and mortality were assessed.. The study had predominantly male patients, average age 47 years. Among the patients in the 2-day group, 3 (4.8%) showed early rebleed versus 5 (8.6%) in the 5-day group, but the difference was not statistically significant (P>0.05). Among the patients in the 2-day group, one patient died after 3 weeks and all the patients in the 5-day group survived till 6 weeks on follow-up, and the survival rates were comparable (P>0.05). The treatment in the 5-day group was 2.5 times costlier than that for the 2-day group as shown by a cost-wise analysis.. Two days of octreotide infusion following endoscopic therapy is sufficient and as efficacious as 5 days of infusion in preventing early rebleed, with reasonably better cost-effectiveness.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Cost-Benefit Analysis; Drug Administration Schedule; Esophageal and Gastric Varices; Esophagoscopy; Female; Follow-Up Studies; Gastrointestinal Agents; Gastrointestinal Hemorrhage; Humans; India; Infusions, Intravenous; Ligation; Male; Middle Aged; Octreotide; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Young Adult

To evaluate the clinical safety and effectiveness of foam sclerotherapy using polidocanol for the treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration (BRTO).. From November 2005 to June 2009, foam sclerotherapy using polidocanol for the treatment of gastric fundal varices by BRTO was performed in 16 patients (male/female 11:5; age range 46-84 years, median 67 years). Foam was made of 3% polidocanol (Aethoxysklerol; Kreussler Pharma, Wiesbaden, Germany), room air, and contrast media, with a ratio of 1:2:1, respectively. The amount of polidocanol (2-24 mL; median 7 mL) depended on the volume of varices.. Technical success was achieved in 15 of 16 patients (93.8%). Technical failure occurred in one patient. All patients were without pain during sclerotherapy. One patient experienced pulmonary edema after the procedure but completely recovered with medical treatment. There was no procedure-related mortality. Patients were followed by endoscopy, computed tomography, or both. Four patients were lost to follow-up. Clinical success was achieved in 10 of 11 patients (91%). Rebleeding occurred in one case during follow-up.. Foam sclerotherapy using polidocanol is clinically safe and effective for the treatment of gastric fundal varices during BRTO.

Topics: Aged; Aged, 80 and over; Balloon Occlusion; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Safety; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Endoscopic sclerotherapy is a well-established treatment for bleeding esophageal varices, although it has a substantial complication rate. A prospective randomized trial was conducted to determine whether endoscopic variceal ligation is safer and more effective than sclerotherapy in adults with bleeding esophageal varices because of extrahepatic portal venous obstruction.. Thirty-six patients underwent sclerotherapy and 37 had band ligation.. Ligation and sclerotherapy were equally effective for achieving variceal eradication (94.6% vs. 91.7%, respectively; p=0.67). However, ligation achieved eradication with fewer endoscopic sessions (3.7 [1.2] vs. 7.7 [3.3]; p <0.0001) and within a shorter time interval (50.1 [17.7] days vs. 99 [54.8] days; p <0.0001). In the ligation group, recurrent bleeding was less frequent (2.7% vs. 19.4%; p=0.028; however, Bonferroni correction for multiple testing removes this significance) and the rate of major complications was lower (2.7% vs. 22.2%; p=0.014). Total cost per patient was significantly higher in the sclerotherapy vs. the ligation group ($216.6 [71.8] vs. $182.6 [63.4]; p=0.035). During the follow-up period after variceal eradication, no significant differences were found between the sclerotherapy and the ligation groups with respect to recurrent bleeding (3% vs. 2.9%; p=1.0), esophageal variceal recurrence (9.1% vs. 11.4%; p=1.0), and formation of new gastric varices (9.1% vs. 14.3%; p=0.51).. Variceal band ligation is superior to sclerotherapy, because it is less costly and achieves variceal eradication more quickly, with lower relative frequencies of recurrent variceal bleeding and complications.

Topics: Adolescent; Adult; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Hypertension, Portal; Ligation; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

A number of sclerosing agents have been tried for sclerotherapy of oesophageal varices. However, none of them have emerged as an ideal agent. Hence, this study was designed to compare the efficacy and safety of sodium tetradecyl sulphate and polidocanol for sclerotherapy of oesophageal varices.. A total of 100 consecutive patients with bleeding oesophageal varices were included in the study. Patients with associated gastric varices and hypersplenism were excluded. Of the 100 patients, 50 received emergency sclerotherapy with either 3 per cent sodium tetradecyl sulphate or 3 per cent polidocanol, randomized using the sealed envelope technique. Following control of bleeding, these patients were included in the elective sclerotherapy schedule. The remaining 50 patients with past history of bleeding varices received elective sclerotherapy. Thus all 100 patients received elective sclerotherapy at 4 weekly intervals.. There was no significant difference between the sodium tetradecyl sulphate and polidocanol groups with respect to the control of acute variceal bleeding (100% vs 96%), the mean number of injection sessions (4.5 +/- 0.3 vs 4.7 +/- 0.4) and the mean amount of scleroscent required (33.3 +/- 2.7 ml vs 37.0 +/- 3.3 ml) per patient for variceal eradication. The cost of polidocanol required for variceal obliteration was significantly higher than that of sodium tetradecyl sulphate (P < 0.001). The use of sodium tetradecyl sulphate in contrast to polidocanol was associated with a significantly higher incidence of variceal recurrence (11% vs 0%) and other complications such as oesophageal ulcer (14% vs 2%), retrosternal pain (22% vs 2%), fever (16% vs 4%), tachycardia (14% vs 2%) and dysphagia (20% vs 6%). Rebleeding rate and mortality rate were not significantly different between the two groups.. Polidocanol is superior to sodium tetradecyl sulphate as it has lower incidence of complications, even though the drugs are similar in efficacy in the control of bleeding and obliteration of varices in long-term.

Topics: Adult; Esophageal and Gastric Varices; Female; Humans; Male; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Sodium Tetradecyl Sulfate

The combination treatment of band ligation plus sclerotherapy has been proposed to hasten variceal eradication. The aim of this study was to assess the efficacy of band ligation alone versus band ligation plus sclerotherapy in the prevention of recurrent variceal bleeding.. Eighty cirrhotic patients were randomized to group I (band ligation) with 41 patients or to group II (band ligation plus sclerotherapy) with 39 patients in whom polidocanol (2%) was injected 1 to 2 cm proximal to each band.. At baseline, both groups were similar with regard to clinical, demographic and laboratory data. Mean follow-up time (standard error) for group I was 336.5 +/- 43.4 days and for group II 386.1 +/- 40.1 days (p = 0.4). No statistical differences were observed between group I and group II in relation to recurrence of bleeding (31.7% vs. 23%, p = 0.38), treatment failure (24.4% vs. 12. 8%, p = 0.18), death (39% vs. 30.8%, p = 0.44) and variceal eradication (65.8% vs. 74.4%, p = 0.40). Group II had a significantly higher number of complications than group I, 30.8% versus 7.3%, respectively (p = 0.05). The number of bleeding related deaths was higher in group I than in group II (22% vs. 10.3%, respectively; p = 0.15).. No significant difference was observed between band ligation and band ligation plus sclerotherapy in prevention of recurrent variceal bleeding. Furthermore, there was a higher incidence of complications in the latter group.

Topics: Combined Modality Therapy; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Ligation; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Sclerosing Solutions; Sclerotherapy; Survival Rate; Treatment Failure

To evaluate the safety and efficiency of variceal ligation compared with endoscopic sclerotherapy, 88 patients with cirrhosis with recent variceal bleeding were randomized to undergo either treatment.. Sclerotherapy was performed using ethanolamine and polidocanol injection at 1, 2, and 3 weeks and every 3 weeks thereafter. The Stiegmann-Goff device was used for variceal ligation at the same intervals.. The rate of variceal eradication was the same for both groups, but eradication was accomplished sooner in patients undergoing variceal ligation (5.3+/-1.6 vs. 6.6+/-2.4 endoscopic sessions, p < 0.05) and with fewer complications (19 vs. 6, p < 0.005). The rate of recurrent bleeding was lower in patients treated by ligation (31% vs. 50%, p < 0.05). After eradication, variceal recurrence was more frequent in patients treated by variceal ligation at 1 and 3 years (47% and 92% vs. 23% and 55%, p < 0.01). Portal hypertensive gastropathy was significantly worse in the patients who had variceal ligation (17 patients vs. 6, p < 0.01). Survival and treatment failure were similar in both groups.. Variceal ligation was superior to sclerotherapy in terms of the rate of recurrent bleeding and the occurrence of complications but worse with respect to recurrence of varices and the evolution of portal hypertensive gastropathy. Long-term follow-up studies are required to find out whether there are deleterious effects of variceal ligation.

Topics: Esophageal and Gastric Varices; Ethanolamine; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Ligation; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Endoscopic ligation (EVL) and endoscopic sclerotherapy (EIS) are both effective in the treatment of bleeding esophageal varices, but the efficacy of the two techniques in the prophylaxis of first variceal bleeding has not been investigated. The aim of this study was to investigate the frequency of first variceal bleeding, the recurrence of varices, and survival after treatment with the two techniques, as compared to a nontreated control group.. A total of 157 patients with liver cirrhosis and advanced esophageal varices with no previous history of upper gastrointestinal bleeding were randomly assigned to either an EIS group (n = 55), an EVL group (n = 52), or a nontreated control group (n = 50). After the eradication of esophageal varices in the EIS and in EVL groups and in all control patients, the endoscopic examination was performed at 3-month intervals.. There were no significant differences between EIS and EVL in the eradication rate of esophageal varices (85% in the EIS group versus 81% in the EVL group). The mean number of sessions required to obtain eradication was lower in the EVL group than in the EIS group (4.8 +/- 1.8 versus 6.2 +/- 2.0; p = 0.0003), but the recurrence of esophageal varices was higher in the EVL group (31% versus 11%; p = 0.01). Total mortality was significantly lower in the EIS patients than in the controls (20% versus 38%; p = 0.04). It was also lower, but not significantly, in the EVL patients than in the controls (23% versus 38%; p = 0.10). A significant decrease in variceal bleeding was observed both in sclerotherapy cases (20%) and controls (54%; p = 0.0005) and in ligation cases and controls (29%; p = 0.01). No significant difference in bleeding episodes was observed between the sclerotherapy and ligation cases (p = 0.29). No serious complications were observed either in the EIS or EVL groups.. EIS and EVL are similarly effective in the prevention of first variceal bleeding. The choice between EIS and EVL depends on the skill of the endoscopic unit. For highly experienced surgeons facing no complications, sclerotherapy seems to be preferable; for all others, it is technically easier to perform ligation.

Topics: Adult; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Ligation; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Sclerosing Solutions

A number of trials have been reported in which a combination of ligation and sclerotherapy was compared with ligation alone, or with sclerotherapy alone. The present trial was carried out to assess whether the combined therapy might achieve more rapid eradication of bleeding esophageal varices.. One hundred and three patients with either active bleeding or stigma of recent bleeding from esophageal varices were randomly assigned to receive ligation plus sclerotherapy, or ligation alone. Ligation was performed with the technique introduced by Stiegmann. Sclerotherapy was carried out using low-volume (1 ml) 1% aethoxysclerol, which was injected into varices proximal to each ligature. Further treatment sessions were held seven days later, and then at two-week intervals, until eradication of the varices was achieved. Endoscopic follow-up examinations were carried out at three-month intervals, or immediately if there was any recurrent bleeding. The mean follow-up period was 14 months.. There were no significant differences between the groups of patients compared with regard to the number of sessions required to eradicate the varices (2.4 +/- 0.7 in the combined group, and 2.3 +/- 0.7 in the ligation group; p>0.05). No significant differences were found between the groups with regard to recurrent bleeding (Fp = 2.882; p > 0.05). Three cases of recurrent bleeding (6%) from treatment-induced ulcers and two cases of recurrent bleeding (4%) from duodenal ulcers were observed with the combined therapy and ligation, respectively. No significant differences in the mortality were found between the groups (Fp = 1.145; p>0.05). Two percent of patients in the ligation group died due to bacterial peritonitis.. Since ligation combined with low-volume sclerotherapy did not reduce the time required for variceal eradication, it can be concluded that the combined therapy is not superior to ligation alone. This mode of endoscopic therapy for the treatment of bleeding esophageal varices is therefore not recommended.

Topics: Combined Modality Therapy; Esophageal and Gastric Varices; Esophagoscopy; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Ligation; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Sclerosing Solutions; Sclerotherapy

Endoscopic band ligation combined with sclerotherapy has been postulated to be superior to ligation alone for the treatment of esophageal variceal bleeding.. A randomized trial of ligation versus combined ligation and sclerotherapy was designed to determine whether combined therapy results in faster eradication of varices compared to ligation alone. Sixty patients were randomized to undergo band ligation or ligation combined with injection of 1 to 2 mL of polidocanol (1%) into each variceal column immediately proximal to the previously placed bands. Therapy was repeated at 1- or 2-week intervals until variceal eradication was achieved. Follow-up endoscopy was performed at 3 months and then at 6-month intervals.. The demographic and clinical characteristics of the 31 patients who underwent ligation were similar to those of the 29 who received combined treatment. Sixty percent of the patients had cirrhosis due to viral hepatitis. No significant differences were found between the combined and ligation alone groups in arresting active bleeding [9 of 9 (100%) vs. 6 of 7 (86%)], units of blood transfusion (3 +/- 0.8 vs. 2 +/- 0.6), number of sessions required to eradicate varices (3.8 +/- 0.5 vs. 3.6 +/- 0.4), treatment failure [2 (17%) vs. 4 (14%)], esophageal varix recurrence [6 (21.%) vs. 2 (6%)], gastric varices formation [4 (14%) vs. 1 (3%)], stricture [1 (3%) vs. 0 (0%)], recurrent bleeding [5 (17%) vs. 7 (23%)], other complications [10 (34%) vs. 9 (29%)], or death [3 (10%) vs. 7 (23%)] during a follow-up period of up to 36 months.. Combined ligation and sclerotherapy does not reduce the number of endoscopic treatment sessions required for variceal eradication and offers no benefit over ligation alone. Because of the lack of benefit, the added procedure time, and the cost, we do not advocate combination therapy, and ligation alone remains the best endoscopic treatment.

Topics: Combined Modality Therapy; Endoscopy; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Ligation; Liver Transplantation; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Postoperative Complications; Prospective Studies; Recurrence; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Sclerosis, injection of cianoacrylate and rubber band ligation are the most commonly used endoscopic techniques for the treatment of bleeding esophageal varices.. To assess the effectiveness of cianoacrylate and polidocanol in the treatment of bleeding esophageal varices.. Sixty eight patients with active variceal bleeding were studied. Bleeding varices were classified as thin, thick or gastric. Bleeding from thin varices was treated with polidocanol. Bleeding from thick or gastric varices was treated with cianoacrylate. Variceal eradication was done with polidocanol.. Bleeding came from thin esophageal varices in 23% of patients and endoscopic treatment stopped bleeding in 95% of them, from thick esophageal varices in 62% and endoscopic treatment was successful in 94% of these, and from gastric varices in 12% and treatment stopped bleeding in 87% of these (in 3% bleeding was considered subcardial). Twenty-five percent of patients bled again during variceal eradication, 12% died due to uncontrollable bleeding and 20% died due to liver failure. During variceal eradication 59% of patients classified as Child Pugh C, died.. Treatment of bleeding esophageal varices with cianoacrylate or polidocanol is effective. Patients classified as Child Pugh C have a had prognosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cyanoacrylates; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions

Endoscopic sclerotherapy is of proven benefit for patients after esophageal variceal bleeding, but is associated with substantial local and systemic complications. Since fibrin glue is a promising agent for endoscopic sclerotherapy of esophageal varices, we compared its safety and efficacy in patients after esophageal variceal bleeding.. In a randomized, controlled trial, 36 patients with an acute episode of variceal bleeding were endoscopically treated with either polidocanol (18 patients) or fibrin glue (18 patients) by intravariceal injections within 12 h of admission. Tissue compatibility, incidence of various complications, episodes of rebleeding and overall survival rates were investigated.. Rebleeding, especially from enrollment to day 28, was less common in the fibrin group (p=0.046), and all patients treated with fibrin glue survived for more than 28 days, whereas five patients treated with polidocanol died within this period. The incidence of sclerotherapy-induced ulcers was significantly lower in the fibrin group than in the polidocanol group (p=0.001), and major complications such as perforation or ulcer bleeding were observed only in the polidocanol group. There were no complications in any group due to activation of systemic coagulation, fibrinolysis or clinically relevant pulmonary embolization.. We conclude that fibrin glue is an efficient and safe agent for endoscopic sclerotherapy of bleeding esophageal varices, especially in the immediate posthemorrhagic period.

Topics: Aged; Esophageal and Gastric Varices; Esophagoscopy; Female; Fibrin Tissue Adhesive; Follow-Up Studies; Hemorrhage; Hemostasis, Endoscopic; Hemostatics; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Sclerotherapy

The therapeutic schedule in bleeding esophageal varices is today established: emergency endoscopy with sclerotherapy or ligation combined with somatostatin and decreasing portal pressure drug followed by repetitive sclerotherapy or ligation. But the approach to varices that do not bleed is not clear.. The authors submit the results of a 6-year sclerotherapeutic program. Since January 1989 they have treated 421 patients with varices and have together performed 4,115 endoscopic sclerotherapeutic procedures. Among the 421 patients 95 were treated during acute bleeding and 254 were treated after first bleeding; in 72 patients prophylactic sclerotherapy (PSG) was performed.. The procedure was indicated, when grade III or IV varices or high-risk signs and/or hepatic venous pressure gradient (HVPG) > 15 in grade II varices were observed. Prophylactic therapy (not-treated group-NTG) refused next 31 selected patients. The mean follow-up time was 32 months in the PS group and 28 months in NTG (n.s.). Fifteen PSG patients died (21%), while the mortality among the NTG patients (13 = 42% patients) was significantly higher (P < 0.02).. We recommend prophylactic sclerotherapy with 1% polidocanol in patients with advanced varices in liver cirrhosis of varied etiology. We emphasize the need to perform these procedures in a department with adequate experience, where at least 100-200 sclerotherapies per year are performed.

Topics: Endoscopy, Digestive System; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Retrospective 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

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

Data concerning the results with emergency and further elective therapy of esophageal varices using polidocanol and cyanoacrylate, or polidecanol alone, in an unselected group of patients with liver cirrhosis have not previously been available. The aim of the present prospective study was to evaluate acute and repeated cyanoacrylate and polidocanol therapy in the emergency and long-term elective management of esophageal varices.. In accordance with the protocol of the present prospective study, acutely bleeding esophageal varices of grades 1 to 3 were treated endoscopically with polidocanol injection, while grade 4 varices, large solitary varices (over 5 mm) and otherwise uncontrollable cases of variceal bleeding were treated by injection of cyanoacrylate and polidocanol. Over a period of 62 months, 112 patients (65 men, 47 women) with acute bleeding from esophageal varices due to cirrhosis of the liver (69% alcohol-related) underwent a total of 245 treatment sessions in hospital. The average age of the patients was 62.0 +/- 12.3 years (58.1% were 60 or older). Hepatic function corresponded to Child-Pugh class A in 38 patients (33.9%), Child-Pugh class B in 68 patients (60.7%), and Child-Pugh class C in six (4.5%).. Sixty-eight patients (60.7%) were treated with polidocanol alone, and 44 (39.3%) with cyanoacrylate and polidocanol. Acute hemostasis was achieved in all cases. In 5.7% of the sclerotherapy procedures, bleeding ulcers were observed, and a pleural effusion was seen in one case. The hospital mortality rate was 24.1%, resulting from the bleeding in 2.7% and due to liver failure in the remaining cases. Recurrent bleeding occurred within 24 hours in four patients (3.6%), and during the later course of the hospital stay in a further 11 patients (9.8%). The mean survival time was 13.7 +/- 17.7 months. Over the entire observation period of 23 +/- 21 months, 67 patients died (59.8%); the cause of death was hemorrhage in 4.5%, the underlying hepatic disease in 65.7%, and non-hepatic causes in 29.8%. Recurrent bleeding occurred in 58 patients (51.7%). The cumulative survival rate in the patients treated with cyanoacrylate and polidocanol was 66 +/- 15% and 26 +/- 32% after one and five years, respectively, and 56 +/- 13% and 33 +/- 19% in those treated with polidocanol alone.. Endoscopic treatment of esophageal varices with cyanoacrylate and polidocanol, or polidocanol alone, is effective in controlling bleeding, and the complication rate is tolerable. The short-term and long-term mortality rates are determined largely by the underlying liver disease.

Topics: Adult; Aged; Cyanoacrylates; Drug Administration Schedule; Drug Therapy, Combination; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prognosis; Prospective Studies; Recurrence; Sclerosing Solutions; Survival Rate

Authors present results of therapy of patients over 60 treated because of nonvariceal upper gastrointestinal bleeding in General Surgery Department in Oświecim. In 1991-1993 47 patients underwent non-endoscopic therapy. In 1994-1996 endoscopic obliteration with 0.01% epinephrine or 1% polidocanol in patients over 60 was applied. In the group over 60 more often concomitant diseases (cardiovascular, diabetes, atherosclerosis) were noted. Similar endoscopic obliteration efficacy (90% vs. 91%) in patients aged under and over 60 was observed. Patients treated with endoscopic obliteration underwent urgent operation twice rarely then conservative management (6.7% vs. 13%). They obtained less quantity of blood (2.23 vs. 3.4 unit). Their hospital stay was shorter (9 vs. 13 days). In both kind of therapy, mortality in patients over 60 was higher then under 60, but less often in group undergone endoscopic obliteration (traditional treatment 28% vs. 6%, endoscopic 15% vs. 2%).. 1. Reason of worse therapy results of upper gastrointestinal bleeding among patients aged over 60 was great number of concomitant diseases. 2. Efficacy of endoscopic obliteration 0.01% epinephrine and 1% polidocanol was independent from age. 3. Application of endoscopic obliteration improved results of therapy in patients aged over 60.

Topics: Aged; Aged, 80 and over; Epinephrine; Esophageal and Gastric Varices; Female; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Length of Stay; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Reoperation; Sclerosing Solutions; Sclerotherapy; Vasoconstrictor Agents

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 severity of esophageal variceal bleeding in cirrhotic patients justifies prophylactic therapy. A multicenter controlled study was carried out in Languedoc in 116 cirrhotic patients with esophageal varices and no history of bleeding. Patients were randomly assigned to two groups: 60 control patients without therapy; 56 patients treated by endoscopic sclerotherapy (209 sessions). The mean follow-up was 20 +/- 11 months. Esophageal varices disappeared in 35 patients (62.5%) or became smaller in 10 other patients (18%). Varices reappeared in 9 of these 35 patients within 3 months. Minor (fever, dysphagia, stenosis) or major complications (variceal bleeding, bacterial peritonitis) were noted in 26 patients (46%). Esophageal variceal bleeding occurred in 13 of the treated patients and in 10 control patients. Actuarial curves of bleeding and survival were similar for both groups. Twenty controls and 21 treated patients died during the study. In conclusion, prophylactic sclerotherapy of esophageal varices should not be performed in cirrhotic patients, considering lack of efficacy and high rate of side effects.

Topics: Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerotherapy

This study reports the final results of a randomized multicenter trial on prophylactic endoscopic sclerotherapy of large esophageal varices in patients with liver cirrhosis. Forty-one patients received prophylactic treatment and 41 patients were in the control group. A first analysis 3 years after beginning the study revealed no significant difference in the distribution of the bleeding free intervals between both groups, but indicated a tendency towards longer survival of patients with prophylactic sclerotherapy. The follow-up of patients was continued for an additional 3 years. After this time, 53.7% of patients in the sclerotherapy group and 39.1% of patients in the control group were still alive. During the study period of 6 years, variceal bleeding was observed in 31.7% of patients in the sclerotherapy group and in 36.6% of patients in the control group. Neither survival nor incidence of bleeding were statistically different between the two groups. The etiology of cirrhosis did not influence the survival.

Topics: Austria; Esophageal and Gastric Varices; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Survival Analysis; Time Factors

Topics: Esophageal and Gastric Varices; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Sclerotherapy

Sixty-six patients with portal hypertension and esophageal varices due to liver cirrhosis were randomized to receive either 5% ethanolamine oleate (EO) or 5% EO plus 1% polidocanol (EOP) as a sclerosant for endoscopic injection sclerotherapy (EIS). The two groups were well matched with regard to age, sex and the severity of liver disease. In no patient in the two groups was there any major complication, such as esophageal perforation or esophageal bleeding. Eradication of esophageal varices was attained with an average of 4.7 and 4.3 sessions of endoscopic injection sclerotherapy in the ethanolamine oleate and polidocanol groups, respectively. Data on one patient in the ethanolamine oleate group had to be excluded because he left the hospital after 2 sessions of endoscopic injection sclerotherapy. Esophageal ulcers occurred earlier in the polidocanol group (after an average of 2.8 weeks) than in the ethanolamine oleate group (3.8 weeks), the difference being statistically significant (P < 0.01). The rate of occurrence of esophageal stricture requiring more than 2 sessions of bougienage was significantly (P < 0.01) higher in the polidocanol group (16/33, 48%) than in the ethanolamine oleate group (4/32, 12%). This study suggests that the two sclerosants have equal efficacy for treating patients with esophageal varices. With polidocanol there was ulceration and stricture in the distal esophagus.

Topics: Drug Combinations; Esophageal and Gastric Varices; Esophagoscopy; Female; Humans; Male; Middle Aged; Oleic Acids; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy

A prospective randomized controlled study was designed to evaluate differences in efficacy and complication rate between the two most commonly used sclerosing agents, sodium tetradecyl sulfate (STD) and polidocanol. Of 52 patients with esophageal variceal bleeding, 26 were randomized to receive sclerotherapy with 1.5% STD and 26 to receive 1% polidocanol at weekly intervals. Eradication of varices was achieved in 88% patients each of the STD and polidocanol group. There was no significant difference between patients injected with STD and polidocanol with regard to re-bleeding (27% vs. 15%) and mortality (11.5% in both). The use of STD, in contrast to polidocanol, was associated with a higher incidence of complications in terms of severe retrosternal pain (27% vs. 4%), deep ulceration (53% vs. 23%), dysphagia (88% vs. 46%), and stricture formation (27% vs. 8%). It was concluded that these two agents were similar in efficacy. However, polidocanol was superior due to a lower incidence of complications.

Topics: Adolescent; Adult; Aged; Child; Drug Evaluation; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Sclerotherapy; Sodium Tetradecyl Sulfate; Survival Analysis

Controlled trials of sclerotherapy for the prevention of the first variceal hemorrhage in cirrhotics have given conflicting results. In the present study, 106 cirrhotics were randomized to sclerotherapy (55 patients) or control group (51 patients). Admission criteria were no history of previous variceal bleeding and the presence of high-risk varices, i.e., a variceal score less than or equal to 0 according to Beppu et al. Sclerotherapy sessions were performed at time zero, 7 days, 30 days, and then monthly until eradication. Follow-up endoscopies were performed at 6-month intervals thereafter. Control patients underwent repeat endoscopy at 6-month intervals. Bleeding episodes were treated by sclerotherapy in both groups, whenever possible. Mean follow-up was 24 months. Analysis of the results was performed by the intention-to-treat method. Variceal bleeding occurred in 19 sclerotherapy patients (34.5%) and in 17 controls (35.4%, P = NS). Overall mortality was 34.5% in sclerotherapy patients and 50% in controls (P = NS). Seven of the 19 sclerotherapy patients (36.8%) and 11 of the 17 controls (64.7%) who bled died of hemorrhage (P less than 0.05, log-linear model). It is concluded that prophylactic sclerotherapy does not reduce the incidence of first variceal bleeding in cirrhotics. However, there seems to be a trend toward a lower bleeding-related mortality in sclerotherapy patients than in controls.

Topics: Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Risk Factors; Sclerosing Solutions; Sclerotherapy

A prospective randomized trial has been undertaken to compare the efficacy of two sclerosing agents, Ethanolamine oleate (Et) and Polidocanol (Pl), in the eradication of esophageal varices (EV). Fifty consecutive cirrhotic patients, 22 in the Et and 28 in the Pl group, were included. Clinical data were comparable in both groups. Eradication of the EV was achieved in 81% (18/22) in the Et group and 64.1% (18/28) in the Pl group (p = NS). There was a significant difference in the rate of rebleeding (4 episodes in 3 patients in the Et group and 18 episodes in 13 patients in the Pl group, p less than 0.05). No differences were noted in the number of other complications or mortality. Both sclerosants have proved useful in the eradication of EV, but Et was superior to Pl in the preventation of recurrent bleeding in the course of repeated endoscopic injection sclerotherapy (EIS).

Topics: Esophageal and Gastric Varices; Female; Humans; Male; Middle Aged; Oleic Acids; Polidocanol; Polyethylene Glycols; Prospective Studies; Randomized Controlled Trials as Topic; Sclerosing Solutions

Topics: Adult; Esophageal and Gastric Varices; Ethanol; Female; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Random Allocation; Sclerosing Solutions

Several prospective studies on the efficiency and technique of endoscopic sclerotherapy (EST) were performed among 300 patients with bleeding esophageal varices, 173 of which had been treated by EST. Contrasted with a comparable control group (n = 80), EST (n = 100) reduced the incidence of rebleedings (40% vs 13.3%; p less than 0.0005) and the lethality (46.7% vs 30.6%; p less than 0.05) during the observation period of 21 months. The paravariceal and the intravariceal injection techniques were compared in 20 patients each. A higher number of initial and repeated treatment sessions argued against the paravaricel technique (mean follow up: 4 years). In a randomized study on prophylactic EST we found a lower bleeding frequency (13% vs 39%) in 16 patients treated by EST compared to 18 controls.

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

Thirty-four consecutive patients with liver cirrhosis and esophageal varices were included in a prospective randomized trial done to investigate the efficacy and safety of two sclerosants 5% ethanolamine oleate (EO) and polidocanol (1% Aethoxysklerol [AS]) for use in endoscopic injection sclerotherapy (EIS). Eighteen patients were randomly allocated to the group given EO and 16 to the AS group. These two groups were comparable with regard to age, sex, etiology and severity of the liver disease. The bleeding rate from esophageal ulcers which developed during the course of repeated EIS was significantly (P less than 0.05) higher in the AS group (31.3%, 5/16) than in the EO group (0%, 0/18). In 4 occasions bleeding from the esophageal ulcer could not be controlled with AS. In 3 of these 4 bleeding episodes, EO successfully halted bleeding from esophageal ulcer. In the other patient, a Sengstaken-Blakemore tube was inserted to stop the hemorrhage. The period and number of sessions of EIS for eradication of esophageal varices were significantly (P less than 0.05) shorter in the EO group than the AS group (EO: 4.0 +/- 0.8 [means +/- SD] sessions during 4.7 +/- 1.5 weeks versus AS: 4.8 +/- 1.2 sessions during 5.4 +/- 1.6 weeks). The rate of early mortality did not differ between the two groups. We conclude that 5% ethanolamine oleate seems to be superior to 1% Aethoxysklerol when used for sclerosing esophageal varices.

Topics: Clinical Trials as Topic; Endoscopy; Esophageal and Gastric Varices; Female; Humans; Male; Middle Aged; Oleic Acids; Polidocanol; Polyethylene Glycols; Prospective Studies; Random Allocation; Sclerosing Solutions

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

In a prospective randomized controlled clinical trial, prevention of hemorrhage from oesophageal varices by repeated peri- and intravariceal injections of 20 ml Aethoxysclerol 1% were compared with medical management alone. The study involved 126 patients with cirrhosis and recent variceal bleeding confirmed by endoscopy. Injection sclerotherapy was carried out using a fiberoptic gastroscope under 10-20 mg intravenous diazepam and 20 mg hyoscin -N-butyl-bromide. Injections were given at monthly intervals. During the first five sessions the agent was given by perivariceal injections followed by five sessions with intravariceal injections. After the 10 months of injection therapy the patients were followed up for 16 months. During the perivariceal injection period 37% of the patients in the sclerotherapy group had further bleeding compared with 39% of the control group. During intravariceal injections 12% of the sclerotherapy group and 38% of the control group had further bleeding (p less than 0.05). During the follow-up of 16 months after sclerotherapy, 16% of the sclerotherapy group and 56% of the control group had further bleeding (p less than 0.05), 35% of the sclerotherapy group and 61% of the control group died in these 26 months of investigation (p less than 0.05). Intravariceal injection sclerotherapy significantly decreased the incidence of further bleeding and mortality in patients with cirrhosis and oesophageal varices. Perivariceal injections did not appear to be effective.

Topics: Adult; Aged; Clinical Trials as Topic; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Injections; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prognosis; Prospective Studies; Random Allocation; Sclerosing Solutions

From January 1, 1978 to January 1, 1980 a controlled randomized trial comparing conservative treatment with prophylactic sclerotherapy of esophageal varices prior to hemorrhage was carried out. In all 71 patients liver cirrhosis was histologically confirmed. The two randomly assigned groups were comparable. Indications of endoscopic treatment were the existence of varices III-IV bearing erosions, varices II-IV without erosions but coagulation factors below 30%, or both. Six patients left the trial. In group Ia -- treatment by conservative means -- a high rate of variceal bleeding and death was observed. Comparing these results with those of group Ib treated by sclerotherapy, bleeding and death rates were found to be highly significantly lower. -- Thus the investigated criteria for predicting a recent variceal hemorrhage are confirmed. Prophylactic sclerotherapy in esophageal varices with erosions and/or poor coagulation reserve of the liver can largely prevent an esophageal hemorrhage from varices, and prolongs the life of these chronically ill patients.

Topics: Clinical Trials as Topic; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Polidocanol; Polyethylene Glycols; Prospective Studies; Random Allocation; Sclerosing Solutions

Like esophageal varices, cardiac varices are often treated with endoscopic variceal ligation (EVL). However, we previously reported that EVL for cardiac varices may be associated with a high risk of rebleeding from the ulcer if the O-ring spontaneously drops off early. The efficacy and safety of para-variceal endoscopic injection sclerotherapy (EIS) with polidocanol for the treatment of cardiac varices in children and adolescents were evaluated.. Eleven patients under 18 years of age with portal hypertension who underwent para-variceal EIS with polidocanol for cardiac varices with red signs, which were considered to be at high risk of bleeding, were retrospectively reviewed.. One session of para-variceal polidocanol-EIS was performed for each of the 11 patients. One patient experienced temporary hypoxia due to aspiration of saliva when the tracheal intubation tube was removed after the procedure but recovered by endotracheal suctioning; there were no other adverse events. In six of the eight cases in which efficacy could be evaluated, eradication of cardiac varices was achieved.. Para-variceal polidocanol-EIS may be considered instead of EVL for small cardiac varices with red signs in pediatric patients with cardiac varices.

Topics: Adolescent; Child; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Ligation; Polidocanol; Recurrence; Retrospective Studies; Sclerotherapy; Varicose Veins

To evaluate the efficacy of three endoscopic therapies of isolated gastric varices (IGV) with modified tissue adhesive.. A retrospective analysis was conducted with the clinical data of 73 IGV patients who were treated between January 2008 and December 2019 at Beijing Ditan Hospital. Patient clinical data on age, sex, etiology, biochemistry findings, Child-Pugh classification, the type of spontaneous shunt, preoperative bleeding history, and the presence or absence of liver cancer were collected. The three therapies evaluated were endoscopic intravenous injection of tissue glue combined with lauromacrogol, endoscopic clip-assisted intravenous injection of tissue glue combined with lauromacrogol, and endoscopic clip and LOOP-assisted intravenous injection of tissue glue combined with lauromacrogol. Their respective clinical treatment outcomes, including ectopic embolism rate, survival rate, rebleeding rate, amount of lauromacrogol and tissue glue used, the number of endoscopic clips used, and the number of times of the procedure the patient underwent, were evaluated.. In the patient baseline data, Child-Pugh grade, preoperative thrombus formation, and the presence or absence of liver cancer, showed significant difference between the three therapies (. The two endoscopic therapies of intravenous injection of modified tissue glue, one assisted by clip and the other assisted by clip and LOOP, can help reduce the number of procedures IGV patients undergo within one year.

Topics: Esophageal and Gastric Varices; Humans; Liver Neoplasms; Neoplasm Recurrence, Local; Polidocanol; Retrospective Studies; Tissue Adhesives

Topics: Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Neoplasm Recurrence, Local; Polidocanol; Stomach Neoplasms; Treatment Outcome; Ultrasonography, Interventional

To report the complications and evaluate the risk factors of elective endoscopic cyanoacrylate injection with lauromacrogol for gastric varices in cirrhotic patients.. A total of 583 elective endoscopic tissue adhesives procedures were performed in 439 patients in our hospital from January 2015 to December 2016. The clinical characteristics and complications were retrospectively collected and evaluated.. The median age was 56 ± 11 years, and 290 (66.1%) patients were male. The main etiology of liver cirrhosis was hepatitis virus (63.3%). Two hundred fifty-nine (59.0%) patients were classified as Child-Pugh Class A. Bleeding occurred in 44 patients (7.5%) during procedures. Two patients developed distant embolism (0.5%; one pulmonary, one cerebra). In perioperative period, fever was a common complication; however, only 16 cases had high fever and one case had sepsis. Bleeding was observed in 7 (1.2%) patients. Overall incidence of the major perioperative complication was 3.8%. The major postoperative complication rate was 10.4% (60/582, 26 rebleeds, 27 ascites increase, 12 new-onset portal vein thrombosis). The complication-related death was 1.6% (one death from embolism, five deaths from rebleeding, one death from refractory ascites). Injection point was the only factor related to the major perioperative complications [odds ratio (OR) = 1.581, 95% CI, 1.086-2.301; P < 0.05]. Etiology of cirrhosis and injection point were independent risk factors of major postoperative complications (OR = 1.830, 95% CI, 1.005-3.331, P = 0.048; OR = 1.373, 95% CI, 1.089-1.731, P = 0.007).. The incidence of complications after elective endoscopic cyanoacrylate injection with lauromacrogol for gastric varices was low. The injection point was the risk factor for both perioperative and postoperative complications.

Topics: Aged; Cyanoacrylates; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Recurrence; Retrospective Studies; Treatment Outcome

Topics: Aged; Balloon Occlusion; Catheterization, Peripheral; Diaphragm; Embolization, Therapeutic; Enbucrilate; Esophageal and Gastric Varices; Ethiodized Oil; Female; Humans; Liver Cirrhosis; Polidocanol; Recurrence; Sclerosing Solutions; Sclerotherapy; Treatment Outcome; Veins

Topics: Cyanoacrylates; Endoscopy, Digestive System; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Injections; Male; Middle Aged; Polidocanol; Prognosis; Recurrence; Retrospective Studies; Risk Factors; Sclerosing Solutions

Balloon-occluded retrograde transvenous obliteration (BRTO) is a widely-accepted treatment for gastric varices (GVs). The purpose of this study was to evaluate the efficacy and safety of BRTO with lauromacrogol foam sclerotherapy.. Between May 2014 and June 2015, 32 patients were treated with lauromacrogol foam. Lauromacrogol foam was made using a combination of agents, with a 2:1:1 ratio of room air: lauromacrogol: contrast media. Patients were followed up using contrast-enhanced computed tomography (CT) and endoscopy.. Technical success was achieved in 31 of 32 patients (96.9%). Portal vein thrombosis occurred in two patients and resolved spontaneously. No other major complications were observed. The overall mean dose of lauromacrogol used was 12.4 mL (range, 8-20 mL). Complete obliteration of GVs was confirmed in all 31 patients (100%) on follow-up CT. Seven of the 31 patients (22.6%) experienced worsening of esophageal varices. Rupture of esophageal varices occurred in three patients and was treated successfully with band ligation. Five patients (16.1%) experienced worsening of ascites and responded well to diuretic therapy.. BRTO utilizing lauromacrogol foam appears to be a safe and useful treatment option in patients with GVs in the short term.

Topics: Adult; Aged; Aged, 80 and over; Balloon Occlusion; Combined Modality Therapy; Contrast Media; Esophageal and Gastric Varices; Female; Humans; Male; Middle Aged; Polidocanol; Radiographic Image Enhancement; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome

To focus on procedure-related complications, evaluate their incidence, analyze the reasons and discuss the solutions.. Overall, 628 endoscopic gastric variceal obturation (EGVO) procedures (case-times) with NBC were performed in 519 patients in the Department of Endoscopy of the Third Affiliated Hospital of Sun Yat-Sen University from January 2011 to December 2016. The clinical data of patients and procedure-related complications of EGVO were retrospectively analyzed.. In the 628 EGVO procedures, sticking of the needle to the varix occurred in 9 cases (1.43%), including 1 case that used lipiodol-diluted NBC and 8 cases that used undiluted NBC (. Although EGVO with tissue glue is usually safe and effective, a series of complications can occur during the procedure that may puzzle endoscopists. There is no standard operating procedure for addressing these complications. The cases described in the current study can provide some reference for others.

Topics: Adult; Enbucrilate; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Gastroscopes; Gastroscopy; Hemostasis, Endoscopic; Humans; Injections; Ligation; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Postoperative Complications; Recurrence; Retrospective Studies; Sclerotherapy; Stomach

The purpose of this study was to evaluate the clinical results of the management of gastric varices by balloon-occluded retrograde transvenous obliteration with polidocanol foam versus ethanolamine oleate.. Twenty patients treated with ethanolamine oleate and 21 patients treated with polidocanol foam were enrolled in this study. Early therapeutic effects were assessed mainly by dynamic contrast-enhanced CT. Subjective symptoms, objective findings associated with the procedures, and changes in laboratory data during the obliteration process were evaluated. Rebleeding from gastric varices was assessed after the procedures.. Complete obliteration was confirmed in all but one case of early recanalization after treatment with polidocanol foam. One patient died of acute respiratory distress syndrome after treatment with ethanolamine oleate. The total sclerosant volume was significantly lower for 3% polidocanol foam (13.5 ± 6.8 mL) than for 5% ethanolamine oleate (30.6 ± 15.6 mL) (p < 0.01). Polidocanol foam caused fewer severe reactions, including pain, during and after injection. High body temperature, hemoglobinuria, and reactive pleural effusion were not observed with polidocanol foam. The variance in laboratory data values associated with hemolysis was significantly greater with ethanolamine oleate. No postprocedural rebleeding from the gastric varices was observed during a median follow-up time of 39.5 months after procedures with ethanolamine oleate and 34 months after procedures with polidocanol foam.. Polidocanol foam can achieve obliteration of gastric varices comparable to that of ethanolamine oleate but with a significantly lower sclerosant dose and reduced risk of hemolysis-induced complications and harmful reactions, including pain and fever.

Topics: Adult; Aged; Aged, 80 and over; Balloon Occlusion; Contrast Media; Esophageal and Gastric Varices; Female; Humans; Male; Middle Aged; Oleic Acids; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Tomography, X-Ray Computed; Treatment Outcome

Topics: Balloon Occlusion; Esophageal and Gastric Varices; Humans; Polidocanol; Polyethylene Glycols; Sclerotherapy

Balloon-occluded retrograde transvenous obliteration has been traditionally based on liquid sclerotherapy. However, overdose and systemic spillage of liquid sclerosant can cause severe complications, such as hemolysis, which lead to hemoglobinuria, allergy, acute respiratory distress syndrome, and other disorders. The purpose of this study was to evaluate the performance of foam sclerotherapy with C-arm CT guidance to reduce the amount of sclerosant and to optimize the safety of balloon-occluded retrograde transvenous obliteration while preserving its efficacy.. Twenty consecutively registered patients with gastric varices underwent balloon-occluded retrograde transvenous obliteration with polidocanol foam. C-arm CT guidance was used to confirm gas filling of the target vessels. In this retrospective analysis of a prospectively encoded database, total net doses of polidocanol used for transvenous obliteration and of contrast medium used for venography before transvenous obliteration were compared, and subsequent complications, including hemoglobinuria, were documented.. In all patients, foam was observed in the target vessels at C-arm CT. The mean dose of polidocanol used for balloon-occluded retrograde transvenous obliteration (3.9 ± 1.5 mL) was significantly smaller (p < 0.001) than the dose of contrast medium used for venography (16.4 ± 7.9 mL). Hemoglobinuria was found in only one patient. Except in one instance of recanalization, full variceal thrombosis was confirmed at contrast-enhanced CT 1 week after transvenous obliteration (success rate, 95%). In one patient, air migrated into the liver during transvenous obliteration but was spontaneously absorbed. No serious complication occurred.. Balloon-occluded retrograde transvenous obliteration with polidocanol foam under C-arm CT guidance allowed significant reduction of sclerosant dose and resulted in a low complication rate while a high technical success rate and efficacy were maintained.

Topics: Aged; Aged, 80 and over; Balloon Occlusion; Contrast Media; Esophageal and Gastric Varices; Female; Hemoglobinuria; Humans; Male; Middle Aged; Phlebography; Polidocanol; Polyethylene Glycols; Radiographic Image Enhancement; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome

Treatment of gastric variceal rupture remains difficult with current options including transjugular intrahepatic portosystemic shunt and endoscopic therapies having significant side effects or reduced efficacy. We report five cases of gastric varices that were successfully treated with balloon-occluded retrograde transvenous obliteration of varices (BRTO) using Polidocanol foam as an alternative sclerosant to ethanolamine oleate.. Patients were recruited with cirrhotic liver disease, a history of upper gastrointestinal bleeding, and large gastric fundal varices confirmed on gastroscopy and CT venogram. BRTO was performed as a same-day procedure using a balloon catheter inserted via a gastro-renal shunt with Polidocanol foam injected and a balloon inflated for 2 h. Follow-up was with repeat CT portovenogram, gastroscopy at 6 weeks post-procedure, and in a gastroenterology liver clinic at 1- to 3-month intervals.. Between January and December 2009, five patients safely underwent BRTO therapy of gastric varices without complication. At 6 weeks following the procedure, upper gastrointestinal endoscopy showed complete resolution of varices in 5 out of 5 patients, while CT portovenography showed resolution of varices in 4 out of 5 patients, with results in the last patient inconclusive. Clinical follow-up at 1, 3 and 6 months indicated no further episodes of bleeding.. Our study further supports the use of foam sclerosants including Polidocanol in BRTO, showing it is a safe and effective minimally-invasive procedure to treat gastric fundal varices in the short term.

Topics: Adult; Balloon Occlusion; Esophageal and Gastric Varices; Female; Humans; Male; Middle Aged; Phlebography; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome

Two patients with liver cirrhosis and portal hypertension related to hepatitis infection were admitted to Shanghai Ruijin Hospital due to recurrent melena and hematemesis. Isolated gastric varices were observed in the gastric fundus during the retroflexion of gastroscope. We carried out endoscopic sclerotherapy successfully for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol, which disappeared dramatically several months after two courses of sclerotherapy for each patient. No complication and clinical signs of gastrointestinal re-bleeding were observed during the 6-mo endoscopic follow-up. CT portal angiography (CTPA) has been widely used in the assessment of variceal treatment and improves the results of endoscopic injection therapy.

Topics: Aged; Cyanoacrylates; Drug Therapy, Combination; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Male; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy

Esophageal varices-related GI bleeding occurs frequently and early in life in children with biliary atresia and it may be life threatening.. We report the results of prophylactic sclerotherapy in 13 infants with biliary atresia and large varices.. Mean age was 13 months, mean weight was 8.2 kg, mean total serum bilirubin was 258 mumol/L, and mean prothrombin time was 78%. Esophageal varices were grade III (11 patients) or II (2 patients), with red signs in all infants and gastric varices in 12. None had GI bleeding.. Sclerotherapy was performed with the patient under continuous intravenous octreotide therapy in 7 infants.. In 8 children a complete or almost complete eradication of varices was obtained; none of these children bled later, 4 underwent liver transplantation, 3 are alive without liver transplantation, and 1 died of sepsis after 9 months awaiting liver transplantation. In 4 children a partial eradication was obtained and liver transplantation was performed. None of these children bled. One other child bled to death after 2 sessions of sclerotherapy.. Four ulcers and 2 stenoses occurred in 6 children with no octreotide versus no ulcer and 1 stenosis in 7 children receiving octreotide.. These results (1) indicate that primary prevention of GI bleeding by sclerotherapy of esophageal varices is technically feasible and fairly effective in infants with biliary atresia and large varices, even in those with end-stage liver disease, (2) suggest that decreasing the risk of bleeding may allow liver transplantation under better conditions, and (3) further suggest that octreotide associated with sclerotherapy lowers the rate of complications.

Topics: Biliary Atresia; Endoscopy, Gastrointestinal; Esophageal and Gastric Varices; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Injections, Intralesional; Male; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Severity of Illness Index; Tissue Adhesives; Treatment Outcome

Topics: Angiography; Diagnosis, Differential; Esophageal and Gastric Varices; Esophagoscopy; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Hypoxia; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Pulmonary Embolism; Sclerosing Solutions; Sclerotherapy; Tomography, Spiral Computed

Topics: Drug Therapy, Combination; Emergency Treatment; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerotherapy; Somatostatin

Topics: Aged; Argon; Electrocoagulation; Esophageal and Gastric Varices; Esophagoscopy; Female; Humans; Injections, Intralesional; Ligation; Male; Middle Aged; Noble Gases; Polidocanol; Polyethylene Glycols; Recurrence; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Endoscopic sclerotherapy has emerged as an effective treatment for bleeding esophageal varices in adults and children but the long-term outcome is poorly defined in children. The present study aimed to study the long-term effect of endoscopic sclerotherapy in children with portal hypertension.. Fifteen patients (age 3 to 14 years) with esophageal variceal bleeding underwent endoscopic injection treatments with 1% Aethoxy-sclerol since 1996. All subjects continued to receive the therapy by repeated intra and extravariceal endoscopic sclerotherapy at intervals of 3 - 4 weeks until the varices disappeared, and received regular endoscopic follow-up.. Fifteen patients had totally 43 injections, and were followed up from 40 to 86 months (mean 66 months) by endoscopy. Two patients received 2 injections and 5 received 3 before eradication of varices. The mean time needed for varices eradication was 3 to 6 months. Recurrence of varices and bleeding was seen in 3 patients who had duodenal ulcer.. Endoscopic sclerotherapy is a safe and effective treatment for pediatric esophageal varices.

Topics: Adolescent; Child; Child, Preschool; Duodenal Ulcer; Esophageal and Gastric Varices; Esophagoscopy; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Injections, Intralesional; Polidocanol; Polyethylene Glycols; Recurrence; Reoperation; Sclerosing Solutions; Sclerotherapy; Time Factors; Treatment Outcome

Endoscopic injection sclerotherapy (EIS) using cyanoacrylate and balloon-occluded retrograde transvenous obliteration (B-RTO) are the main procedures used to treat gastric varices. However, neither technique is free of problems. EIS for gastric varices may cause embolism in other organs; B-RTO requires a gastrorenal shunt and may aggravate esophageal varices. We have developed a combined form of endoscopic therapy involving band ligation and sclerotherapy which is an effective and safe procedure for treating gastric varices.. Fifty-six patients with gastric varices and liver cirrhosis were treated at Almeida Memorial Hospital from June 1997 to May 2002 using the combined procedure. Each gastric varix was tightly ligated with O-rings, and 1 % polidocanol was injected into the submucosa around the ligated varix. If necessary, additional sclerotherapy was carried out after the initial treatment.. The rate of hemostasis for variceal bleeding was 100 %, and no critical complications were noted. Complete disappearance of the gastric varices was observed endoscopically in all cases. Computed tomography showed that collateral vessels outside the gastric wall were not occluded by the treatment. Endoscopic follow-up examinations were carried out, and gastric varices recurred in seven patients (12.5 %). Only two of the patients (3.6 %) had a small amount of oozing bleeding. Additional endoscopic variceal ligation (EVL) and/or EIS were performed in these seven cases, and none of the patients died as a result of a bleeding gastric varix.. The combined procedure was easily performed immediately after endoscopic examination, and required no special apparatus. It was found to be a safe and effective method of treating gastric varices.

Topics: Adult; Aged; Aged, 80 and over; Combined Modality Therapy; Endoscopy, Digestive System; Esophageal and Gastric Varices; Female; Humans; Ligation; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Topics: Esophageal and Gastric Varices; Esophageal Diseases; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy

Topics: Endoscopy, Digestive System; Equipment Design; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Injections, Intralesional; Ligation; Needles; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Endoscopic variceal ligation (EVL) is a recently developed alternative to endoscopic injection sclerotherapy (EIS) for the treatment of oesophageal varices. Endoscopic variceal ligation and EIS were compared in an attempt to clarify the efficacy and safety of EVL for patients with cirrhosis due to hepatitis C.. Endoscopic variceal ligation was performed in 60 patients and EIS in 30. Varices were eradicated in all patients by EVL and 87% (26 out of 30) by EIS.. There was no significant difference between EVL and EIS in relation to the incidence of bleeding and the 5 year survival rate after treatment. There were no severe complications except mild substernal pain after EVL, while pulmonary embolism occurred in one patient receiving EIS.. Endoscopic variceal ligation is a safe and effective technique for eradicating oesophageal varices in patients with hepatitis C cirrhosis.

Topics: Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Hepatitis C; Humans; Ligation; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Time Factors; Treatment Outcome

Xiao zhi ling (XZL), which consists of Chinese nutgalls and aluminium potassium sulphate, is used as a local injection for the treatment of internal haemorrhoids in China. It is also used for endoscopic sclerotherapy of oesophageal varices. To date, however, it has not been compared with other sclerosants with regard to its safety and efficacy.. In the present study, the effect on the endothelium and the haemolytic and thrombosing effects of XZL were compared with those of 5% ethanolamine oleate and 1% polidocanol, using an endothelial cell line and red blood cells taken from rats and the dorsal marginal ear vein of rabbits. In addition, XZL was injected into the area surrounding varices in rats and its efficacy was studied endoscopically and histologically.. Xiao zhi ling reduced the size of varices in rats after causing severe damage in the injected region. Compared with the other two sclerosants, however, XZL had little effect on the endothelium and was the least haemolytic compound. Furthermore, XZL did not cause thrombosis in the injected vein of a rabbit.. These results suggest that XZL is another type of sclerosant with astringent rather than detergent properties. This compound should be used to treat oesophageal varices by paravariceal injection in smaller doses than 5% ethanolamine oleate and 1% polidocanol.

Topics: Alum Compounds; Animals; Astringents; Cattle; Cell Line; China; Dose-Response Relationship, Drug; Drugs, Chinese Herbal; Endothelium, Vascular; Erythrocytes; Esophageal and Gastric Varices; Hemolysis; Male; Oleic Acids; Polidocanol; Polyethylene Glycols; Rabbits; Rats; Rats, Wistar; Sclerosing Solutions; Sclerotherapy; Thrombosis

We assessed the efficacy and safety of endoscopic therapy for esophageal varices in Japanese patients comparing the results of ligation therapy performed in 101 patients with those of sclerotherapy with paravariceal injection of polidocanol in 40 patients. Both therapies were effective in controlling active hemorrhages. Hemostasis rates at the first endoscopic session were 100% in both groups and rebleeding rates were 40.0% in the sclerotherapy and 29.6% in the ligation group. Variceal eradication was achieved equally in both groups in approximately 90% of the patients. However, the ligation achieved eradication more quickly in fewer endoscopic sessions than did the sclerotherapy (mean; 2.1 vs. 3.7 sessions, P < 0.01). Complications such as rebleeding and intramural hematomas were less common in the ligation group. These results indicate some advantages of the ligation over the sclerotherapy. A disadvantage of the ligation therapy is that recurrence occurs more quickly than in the sclerotherapy, although the difference was not statistically significant.

Topics: Endoscopy; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Injections; Ligation; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Postoperative Complications; Recurrence; Sclerosing Solutions; Sclerotherapy

The dose- and time-dependent effects of endoscopic sclerotherapy on luminal cross-sectional area and wall distensibility were studied in pigs at 5 and 12 cm proximal to the gastroesophageal junction by means of impedance planimetry. Sixteen healthy animals underwent two sessions of endoscopic sclerotherapy two weeks apart with injections of either 5 or 10 ml of 1% Polidocanol in the distal 7 cm of the esophagus each time. The animals were investigated before sclerotherapy, two weeks after each session, and finally six weeks after the last session. Six healthy animals were studied as controls. Endoscopic sclerotherapy caused luminal narrowing in the sclerosed zone followed by normalization six weeks after the last treatment (P < 0.05 in both groups). Wall distensibility decreased in the sclerosed zone after treatment with 10 ml sclerosant (P < 0.05) followed by partial normalization, while no effect was found after 5 ml sclerosant (P > 0.2). Progressive dilations were observed in the proximal esophagus in both groups and were most pronounced in the 10 ml group (P < 0.05). Wall distensibility did not change proximal to the site of sclerotherapy in either group (P > 0.1).

Topics: Animals; Esophageal and Gastric Varices; Esophagus; Female; Hemostasis, Endoscopic; Polidocanol; Polyethylene Glycols; Pressure; Sclerosing Solutions; Sclerotherapy; Swine; Time Factors

A 79-year-old man was admitted with a history of recent haematemesis and tarry stools. 4 years before he had undergone a subtotal thyroidectomy for hyperthyroidism.. He was anaemic (haemoglobin 7.2 g/dl, haematocrit 23%). At the transition between the upper and middle third of the oesophagus gastroscopy revealed a bleeding oesophageal varix.. The bleeding varix was sclerosed with polidocanol. 3 erythrocyte concentrates were administered. Massive bleeding 2 days later was controlled with intravaricose injection of cyanoacrylate (Histoacryl). The patient died 6 weeks later from progressive cardiovascular failure. Autopsy revealed the cause of death as right heart failure with extensive foreign-body pulmonary emboli identified as thrombotic material containing polymerized cyanoacrylate found in the previously injected oesophageal varix. Also discovered was a retrosternal goitre which had compressed the brachiocephalic vein. Cause of the "washing-out" of the cyanoacrylate embolus from the varix into the systemic circulation was an oesophago-varicose collateral circulation in a cranio-caudal direction; this had been formed by the pressure of the retrosternal goitre on the brachiocephalic vein.. Cyanoacrylate injection into a varix above the lower third of the oesophagus should only be done under strict indication. A similar risk as that described in this case potentially exists in the treatment of acute bleeding from a portosystemic varicose circulation.

Topics: Aged; Autopsy; Embolization, Therapeutic; Enbucrilate; Esophageal and Gastric Varices; Foreign Bodies; Gastrointestinal Hemorrhage; Humans; Male; Polidocanol; Polyethylene Glycols; Pulmonary Embolism; Sclerosing Solutions

A 74-year-old female with idiopathic myelofibrosis (IMF) was admitted to our hospital because of massive hematemesis and melena. Immediate upper gastrointestinal endoscopy revealed an intermittent spurting hemorrhage from extensive esophageal varices. Endoscopic injection sclerotherapy (EIS) was carried out and the bleeding ceased. After five courses of EIS, all the esophageal varices were eradicated. About 15 months later, the patient died, due to a cerebral hemorrhage, without further variceal bleeding. A postmortem examination was carried out and the portal hypertension was considered to be due not only to extramedullary hematopoiesis in the sinusoids, but also to increased splenic blood flow. We are confident that EIS is an effective therapeutic procedure for patients with IMF showing esophageal variceal hemorrhage. EIS should be the preferred choice of treatment for esophageal varices in patients with IMF, since it is less invasive than splenectomy.

Topics: Aged; Esophageal and Gastric Varices; Esophagoscopy; Fatal Outcome; Female; Gastrointestinal Hemorrhage; Humans; Polidocanol; Polyethylene Glycols; Primary Myelofibrosis; Sclerosing Solutions; Sclerotherapy

Within the framework of a retrospective study complications of endoscopic variceal sclerotherapy were analyzed. From April, 1, 1988 till August, 31, 1994 267 consecutive patients (158 male, 109 female, mean age 43 [27-78] years) with esophageal variceal hemorrhage due to liver cirrhosis and portal hypertension underwent endoscopic variceal injection treatment. Sclerotherapy was performed with 24.5 ml (12-34 ml) 1% of polydocanole on average per treatment. Each patient had 4.5 (2-7) therapy sessions on average. Local complications were: Transient dysphagia (73%), chest pain (65%), esophageal ulcerations (63%), ulerogenic bleeding (14%), posttherapeutic hemorrhage (13%), esophageal strictures (10%), pleural effusions (9%), subfebrile temperatures (6.4%), pericarditis (0.4%) and esophageal perforation (0.4%). No patient died from sclerotherapy-induced side effects. In conclusion, endoscopic injection therapy is an efficient treatment of acute variceal hemorrhage. Not severe local complications often occur, severe side effects are extremely rare, however.

Topics: Adult; Aged; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Retrospective Studies; Risk Factors; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Sclerotherapy results in significant local complications, both immediate and delayed. This study was designed to examine the esophageal pathophysiology underlying these complications.. We prospectively evaluated esophageal transit, motility abnormalities and gastroesophageal reflux (GER) with barium studies and esophageal functional scintigraphy in 24 patients (20 men, 4 women; mean age 33 +/- 12.4 yr) before sclerotherapy (Phase I), after two sessions (Phase II), following variceal eradication (Phase III) and 4 wk later (Phase IV).. Varices were obliterated after 5.6 +/- 1.9 sessions of intravariceal sclerotherapy performed weekly with 1% polidocanol (17.3 ml per session). There was no baseline Phase I dysmotility or reflux. Phase II studies recorded a marked delay of esophageal global and segmental (mid and distal) transit time in 98.2% of patients by scintigraphy and 90% by barium studies. Incoordinate contractions and aperistalsis were observed in 0, 66.7%, 58.3% and 33.8% of patients from Phases I-IV studies, respectively. Barium studies revealed tertiary waves and reverse peristalsis in 0, 50%, and 75% of patients from Phases I-III; strictures were observed in 0, 1, and 3 patients during Phases I-III. GER was detected scintigraphically in 0, 58.3%, 25% and 16.6% during Phases I-IV sequentially. In contrast, barium studies grossly underestimated GER (0, 5% and 15% at phases I-III).. There was strong concordance between esophageal symptoms, transit, motility abnormalities and GER (p < 0.05). Variceal eradication (Phases III and IV) was associated with a gradual recovery of esophageal symptoms, ulcers and all abnormal scintigraphic parameters. Sclerosant-induced chemical esophagitis in association with peptic esophagitis due to gross reflux following sclerotherapy possibly can explain the symptoms in most patients.

Topics: Adult; Barium Sulfate; Esophageal and Gastric Varices; Esophagus; Female; Gastroesophageal Reflux; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Male; Organotechnetium Compounds; Peristalsis; Phytic Acid; Polidocanol; Polyethylene Glycols; Radiography; Radionuclide Imaging; Sclerosing Solutions; Sclerotherapy

Partial ligation of the portal vein has been shown to induce not only prehepatic portal hypertension but also esophageal varices in the rat. We developed an esophageal endoscopic system for endoscopic sclerotherapy of esophageal varices in rats. In the present study the efficacy of three sclerosing agents, 1% polidocanol, 5% ethanolamine oleate, and 99.5% ethanol, was compared, using this model.. Sclerosing agents were injected paravariceally in 42 rats with partial portal vein ligation. Their efficacy was compared endoscopically and histologically.. Ethanol induced the most severe ulcers and subsequent stricture formation. The damage induced by 1% polidocanol was mild and healed quickly, whereas 5% ethanolamine oleate induced moderate damage. The varices disappeared because of fibrosis that developed after ulceration.. The results were consistent with the known properties of these three agents, suggesting that the esophageal endoscopic system for sclerotherapy in rats provides a useful method for experimental studies of sclerotherapy.

Topics: Animals; Esophageal and Gastric Varices; Ethanol; Hemostasis, Endoscopic; Male; Oleic Acids; Polidocanol; Polyethylene Glycols; Rats; Rats, Wistar; Sclerosing Solutions; Sclerotherapy

Topics: Adult; Chest Pain; Dyspnea; Echocardiography; Electrocardiography; Esophageal and Gastric Varices; Humans; Male; Myocarditis; Pericarditis; Polidocanol; Polyethylene Glycols; Sclerotherapy

Topics: Esophageal and Gastric Varices; Fibrin Tissue Adhesive; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Polidocanol; Polyethylene Glycols; Sclerotherapy

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

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

Small esophageal varices are difficult to inject intravariceally and complete eradication of varices may not be therapeutically necessary.. A prospective study designed to compare the use of different end points of sclerotherapy ie (i) total eradication (grade 0) (ii) grade I varices or (iii) grade II white (IIw) varices, by stopping variceal injection when one of these was reached. The patients were followed endoscopically and clinically at 3-4 mo intervals.. Variceal recurrence and rebleeding rates.. Of 266 patients with portal hypertension (147 cirrhosis, 51 non-cirrhotic portal fibrosis, 68 extra-hepatic portal venous obstruction), 232 (87.2%) reached one of the three end points--six to grade 0, 96 to grade I and 130 to grade IIw. Among 212 patients followed up for a mean post-sclerotherapy period of 12.2 mo (range 3-48 mo), variceal recurrence rates, time intervals to recurrence and rebleed rates were comparable in patients with endpoints of grade I and grade II (white) varices (28.5% vs 38.9%, 10.8 mo vs 9.2 mo, and 7.7% vs 7.8%, respectively; all p = ns). Overall, 51 patients had interval bleed before reaching the end point--50 (98%) of them bled from grade III and IV varices while only one patient (2%) bled with grade IIw varices.. Grade I or grade IIw varices should be acceptable as the end points for endoscopic sclerotherapy of esophageal varices.

Topics: Adult; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Male; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

Topics: Aged; Esophageal and Gastric Varices; Esophageal Diseases; Hematoma; Humans; Male; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Topics: Contraindications; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Sclerotherapy

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

Topics: Adult; Blood Flow Velocity; Carcinoma, Squamous Cell; Cardia; Esophageal and Gastric Varices; Esophageal Neoplasms; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemoperitoneum; Humans; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stomach Ulcer; Ultrasonography

The effect of sclerotherapy of esophageal varices on the gastroesophageal reflux was studied. Gastroesophageal reflux was monitored by a 24-h pH-monitoring catheter introduced into the distal esophagus. The results of pH monitoring of 16 patients who underwent sclerotherapy were compared with those of 21 patients with untreated varices. Seven of the 16 treated patients showed high occurrence rates of gastroesophageal reflux comparable to those observed in cases with severe reflux esophagitis. In the untreated group, only one patient showed pathological reflux (there was a significant difference between treated and untreated groups; p less than 0.01). When the level of reflux was compared with factors that might influence sclerotherapy-induced gastroesophageal reflux, there was a positive correlation between the magnitude of reflux and amount of sclerosant injected paravariceally in the submucosal tissue (p less than 0.05). The results indicate that the paravariceal injection of sclerosant for the treatment of esophageal varix may cause pathological gastroesophageal reflux after sclerotherapy is completed.

Topics: Analysis of Variance; Esophageal and Gastric Varices; Esophagus; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Middle Aged; Monitoring, Physiologic; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy

The effects of five sclerosants used for treating esophageal varices on blood coagulation and fibrinolysis, systemic hemodynamics, and vascular endothelial cells were studied in mongrel dogs. With each sclerosant, hemolysis and a decrease in the platelet count were observed. Changes in the blood coagulation system occurred immediately after sclerosant administration. Prolongation of the PT and APTT and decreases in fibrinogen and alpha 2-PI were seen in the thrombin (TH), sodium tetradecyl sulfate (STS), and ethanolamine oleate (EO) groups. Polidocanol (PO) and absolute ethanol (ET) had less pronounced effects on these systems. A transient decrease in the cardiac index (CI), pulmonary artery pressure (PAP) and pulmonary artery resistance (PAR) was observed with the administration of the sclerosants, especially in the TH and STS groups. Excessive vascular endothelial damage was observed in the ET group, marked damage was seen in the EO and STS groups and slight damage was recorded in the PO and TH groups.

Topics: Animals; Blood Coagulation; Dogs; Endothelium, Vascular; Esophageal and Gastric Varices; Fibrinolysis; Hemodynamics; Oleic Acids; Platelet Count; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sodium Tetradecyl Sulfate; Thrombin; Thrombophlebitis

During intravariceal sclerotherapy of esophageal varices with polidocanol in 32 patients with portal hypertension due to liver cirrhosis of various etiologies, endosonographic assessment of both esophageal and gastric intramural vessels was carried out in order to evaluate the usefulness of endosonography in the follow-up of the variceal status. In all cases endosonography demonstrated esophageal and gastric varices; in contrast, only five cases of gastric varices could be demonstrated by endoscopy. Furthermore, different stages of variceal obliteration following sclerotherapy could be demonstrated by means of endosonography, and it was possible to identify incomplete obliteration in about one-third of the patients in whom inadequate sclerotherapy was suspected endoscopically. In addition, the status of gastric varices during sclerotherapy was demonstrated by means of endosonography. Only in cases of adequate sclerotherapy of esophageal varices, as assessed by both endoscopic and endosonographic criteria, were gastric varices plugged. On the basis of these findings endosonography would appear to be a useful technique for the diagnosis and follow-up of esophageal and gastric varices during intravariceal sclerotherapy.

Topics: Esophageal and Gastric Varices; Evaluation Studies as Topic; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Cirrhosis, Alcoholic; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Ultrasonography

Two patients with cirrhosis are presented who developed retrosternal pain and dysphagia immediately after sclerotherapy of esophageal varices. Extensive submucosal bleeding of the esophageal wall was demonstrated radiologically and endoscopically. Complete resolution occurred spontaneously and did not lead to residual complications such as strictures. Intramural hematoma of the esophagus is an unusual complication after endoscopic variceal sclerotherapy.

Topics: Adult; Esophageal and Gastric Varices; Esophageal Diseases; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy

In 27 variceal patients completely treated by ethanolamine oleate and polidocanol and followed for more than one year, the recurrence of varices was studied by measuring portal vein pressure and oxygen tension in the portal vein and peripheral arteries and veins before and after EIS. Frequent recurrence was observed in patients with increased PVP after EIS and lower or inverse PVO2-VO2 tension after EIS. The recurrence of varices after EIS may thus possibly be predicted based on portal vein pressure and PVO2-VO2 tension differences.

Topics: Esophageal and Gastric Varices; Humans; Oleic Acids; Oxygen; Polidocanol; Polyethylene Glycols; Portal Vein; Prognosis; Recurrence; Sclerosing Solutions; Sclerotherapy

Although an increasing number and variety of complications of endoscopic injection sclerotherapy (EIS) of bleeding esophageal varices have been reported, infectious complications are rare. A case of brain abscess following EIS is reported which was characterised by an unusual clinical presentation in that there was no fever or leucocytosis. This presentation could have led to the abscesses being mistaken for brain metastases. The outcome of antimicrobial therapy was favorable which provided further evidence in support of the diagnosis.

Topics: Anti-Bacterial Agents; Brain Abscess; Diagnosis, Differential; Esophageal and Gastric Varices; Esophagoscopy; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed

Variceal hemorrhage in a patient with non cirrhotic portal hypertension occurring in mid pregnancy was treated by endoscopic intravasal injection sclerotherapy using polidocanol. It was effective, well tolerated and safe for both mother and child. This is the first report that this treatment is feasible and without risk in pregnancy.

Topics: Adult; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Polidocanol; Polyethylene Glycols; Portal Vein; Pregnancy; Pregnancy Complications, Cardiovascular; Sclerosing Solutions; Thrombosis

Topics: Esophageal and Gastric Varices; Heart Arrest; Humans; Infant; Polidocanol; Polyethylene Glycols; Sclerotherapy

Between April 1984 and October 1988, 10 patients with hepatocellular carcinoma who bled from esophageal varices were included in a polidocanol sclerotherapy program, after the cessation of bleeding. Sixty cirrhotic patients without hepatocellular carcinoma were included as controls in the same sclerotherapy program for the same period. According to Okuda's classification, 1 patient was grade I, and 9 were grade II. At 1 year, 41 percent of patients with hepatocellular carcinoma and 51 percent of controls had rebled (non significant). Varices were obliterated in 7 of 10 patients with hepatocellular carcinoma and in 41 of 60 control patients (non significant). At one year, treatment failed (rebleeding or death) in 54 percent patients with hepatocellular carcinoma and in 59 percent control patients (non significant). Child-Pugh's score was the principal prognostic factor for treatment failure in both groups. Portal vein thrombosis was found in 2 of the 3 hepatocellular carcinoma patients who rebled. Unlike propranolol, elective sclerotherapy treatment might be proposed to patients with hepatocellular carcinoma without portal thrombosis.

Topics: Aged; Carcinoma, Hepatocellular; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis, Alcoholic; Liver Neoplasms; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prognosis; Recurrence; Sclerotherapy

The author reports the preliminary results of an unrandomized trial comparing the effect of endoscopic variceal sclerosis, shunt surgery and medical therapy in the management of cirrhotic patients with variceal bleeding, sixty-six patients were studied, among them 23 received sclerosis, 25 shunt surgery and 18 medical therapy. Survival was significantly (P less than 0.001) improved in the group with sclerotherapy, with 85% one year survival rate as compared with 45% in the group with shunt surgery and 21% in the group with medical therapy.

Topics: Adult; Aged; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy

Topics: Esophageal and Gastric Varices; Esophageal Diseases; Esophageal Perforation; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Ulcer

This retrospective analysis includes all patients in whom endoscopic sclerotherapy was initiated because of bleeding oesophageal varices during the years 1984 to 1986. Of the total of 107 patients (77 men, 30 women, mean age 56 years) a majority of 71 (66.3%) had alcoholic liver disease as the underlying cause of portal hypertension. Varices were injected with ethoxysclerol 1% in weekly sessions if possible until they were completely eradicated. Initially 27 patients (25.2%) were classified as Child's class A, 52 (48.5%) as Child's class B and 27 as Child's class C. At the time of analysis 46 patients (42.9%) had died. 17 patients died of uncontrolled variceal haemorrhage one of them after a completed course of sclerotherapy, 15 died in hepatic coma. The cumulative survival rate after one year was 63.8% overall, 84.7% for patients in Child's class A, 75.4% for patients in Child's class B and 21.3% for patients in Child's class C. The one year survival rate for the 50 patients who failed to complete a course of sclerotherapy was 26.9%. The one year survival rate for alcoholics as a group (63%) was the same as for non-alcoholics (64.2%). 40 patients had non-fatal episodes of bleeding, 15 of whom bled after completion of a course of endoscopic sclerotherapy (median delay 174 days after completion of sclerotherapy). We conclude from our results that the outcome after sclerotherapy for oesophageal varices is determined mainly by the severity of the underlying liver disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Liver Diseases, Alcoholic; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prognosis; Retrospective Studies; Sclerosing Solutions

Thirty children, aged 7 months to 13 years, with bleeding esophageal varices were managed by endoscopic sclerotherapy (EST). Of these children, 73.3% had extrahepatic portal vein obstruction (EHPVO), 16.6% had cirrhosis of the liver, and 10% had noncirrhotic portal fibrosis. EST was done with fiberoptic pediatric upper gastrointestinal endoscopes and a flexible sclerotherapy needle under sedation with intravenous diazepam and pentazocine. The sclerosants used were ethoxysclerol 1% and absolute alcohol. Ten injections were given to control active variceal bleeding, and 145 injections were given on planned basis at 2-3-week interval. An average of five injections was required to obliterate the esophageal varices. In 90% of cases, an avariceal state was achieved; 10% had decreased size and number of varices. Emergency EST was effective to control bleeding in all sessions. Complications, including retrosternal discomfort, esophageal ulceration, stricture formation, and aspiration pneumonia, occurred in 60, 20, 20, and 6.6% of cases, respectively; complications were managed conservatively. Strictures were dilated with Eder-Puestow's olive dilators. Recurrence of esophageal varices, gastric varices, and rebleeding was seen in 13.3, 13.3, and 10% of cases, respectively. Shunt surgery was performed in 13.3% cases, who had developed gastric varices and were having EHPVO.

Topics: Adolescent; Alcohols; Child; Child, Preschool; Endoscopy; Esophageal and Gastric Varices; Female; Humans; Infant; Male; Polidocanol; Polyethylene Glycols; Recurrence; Sclerotherapy

Topics: Esophageal and Gastric Varices; Esophagoscopy; Humans; Injections, Intralesional; Injections, Intravenous; Needles; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Sclerotherapy; Ulcer

Topics: Animals; Esophageal and Gastric Varices; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy

Topics: Drug Combinations; Esophageal and Gastric Varices; Ethanol; Humans; Polidocanol; Polyethylene Glycols; Sclerotherapy; Thrombin

In injection sclerotherapy against esophageal varices, the damage of the endothelial cells of varices has been supposed to be most important for the formation of thrombi in the injected varices. Mechanisms of the destructive action of three sclerosants (ethanolamine oleate [EO], Aethoxysklerol [AS] & absolute ethanol [Et]) on endothelial cells of varices were studied by means of observation of morphological change of the cells and 51Cr release from the cells in a contact with these sclerosants using cultured human endothelial cells and culture cell line K-562 as target cells. Main mechanism for destructive action of EO on the endothelial cells was considered to be cytolysis through injury of cell membrane, since the cells disappeared immediately after addition of EO with marked release of 51Cr. The destructive action of AS on endothelial cells was considered to be mild cytolysis, since moderate destruction of the cells and moderate release of 51Cr were induced with AS. On the other hand, Et showed a fixative-destructive action on the cells without marked morphological change and with little release of 51Cr. Therefore, it was considered that EO and AS caused the damage of endothelial cells through their lytic action of the cell membrane, whereas Et caused it through the fixative action of the cell membrane.

Topics: Cells, Cultured; Endothelium, Vascular; Esophageal and Gastric Varices; Ethanol; Humans; Leukemia; Oleic Acids; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Tumor Cells, Cultured

Topics: Esophageal and Gastric Varices; Esophagoscopy; Fiber Optic Technology; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Cirrhosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy

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

Gastric bezoars were observed after esophageal variceal injection of polidocanol in 5 of 56 patients with alcoholic cirrhosis treated by endoscopic sclerosis. We suggest that endoscopic sclerotherapy could have induced a transient vagal injury resulting in delayed gastric emptying and subsequent bezoar formation. Although the volume of sclerosant (25-35 ml per session) and the length of the injector needle (4 mm) were the same in all patients, two reasons could explain the occurrence of bezoars in these five patients: a deeper injection of sclerosant, and a worsening of a preexistent vagal neuropathy due to diabetes mellitus and/or alcoholism.

Topics: Adult; Aged; Bezoars; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastric Emptying; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Radiography; Sclerosing Solutions; Stomach; Vagus Nerve

Sixty patients with variceal bleeding due to noncirrhotic portal fibrosis were treated by repeated endoscopic injection sclerotherapy. During each session, the varices were injected with a mean volume of 14.4 ml of 1% polidocanol intravariceally. This decreased rebleeding, as evidenced by a reduction in mean bleeding risk factor and transfusion requirement. Difference between pre- and post-sclerotherapy parameters were significant (p less than 0.001). Variceal obliteration was achieved in 53 (88%) patients. The mean sclerotherapy sessions required for eradication were 8.43 (SD = 2.41). Minor complications related to the procedure occurred in 12% of patients. Cumulative survival for 5 yr was 86%. Survival was significantly related to Child's status, being 97.5% for Child's A and 64% for Child's B patients. Recurrence of varices occurred in 15% of patients after a mean interval of 19 months. We conclude that endoscopic sclerotherapy is an effective method of treatment for variceal bleeding due to non-cirrhotic portal fibrosis, and is a reasonable alternative to surgery.

Topics: Adult; Endoscopy; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Male; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Sclerotherapy; Time Factors

Topics: Adult; Aged; Esophageal and Gastric Varices; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

An examination of esophageal function using manometric techniques and long-term pH measurement was carried out on 14 patients suffering from cirrhosis of the liver who had esophageal varices. The resting pressure in the lower esophageal sphincter was found to be slightly reduced in 50 per cent of those examined, while 100 per cent showed a slightly reduced contraction amplitude in the distal tubular esophagus which became progressively lower in the distal direction, and a pathological gastro-esophageal reflux was observed in 57 per cent. We were able to carry out a control examination on 10 of these patients after sclerosing procedure. Sclerotherapy was found to have lowered resting pressures in the lower esophageal sphincter in 80 per cent of those patients, while all of them showed a grossly impaired tubular peristalsis in the form of simultaneous, mostly repetitive contractions with a considerably lowered contraction amplitude, however it had no negative influence on gastro-esophageal reflux patterns.

Topics: Adult; Aged; Alcoholism; Esophageal and Gastric Varices; Esophagus; Female; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Hypertension, Portal; Male; Manometry; Middle Aged; Peristalsis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Topics: Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

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

Our experiences confirm that with endoscopical paravasal longterm sclerosing of esophageal varices the incidence of recidive bleeding can be clearly reduced and the probability of survival of the patients treated with this method can be improved. Recidive bleeding occurred in 38% of those patients treated with longterm sclerosing, in a conservatively treated group, on the other hand, in 61% of the cases. At the end of the observation period (January 1980 to December 1984) two thirds of the patients treated with sclerosing remained alive, in the control group, however, only one half of 71 patients survived. This favourable result can be attributed to reduced mortality because of bleeding, since the mortality of coma hepaticum and of other rare causes of death is nearly equal in both groups of patients.

Topics: Adult; Aged; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Liver Cirrhosis; Long-Term Care; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prognosis

The sclerosant effect of injected tetradecyl sulfate of sodium (STS) and hydroxy polyethoxy dodecan (HPD) was studied in the rat femoral vein. Intravenous (i.v.) and intravenous plus perivenous (i.v. + p.v.) injections of both sclerosants and physiologic saline were compared as to vein lumen occlusion, fibrosis, phlogosis, and damage to the artery and surrounding nervous and muscular tissues. The study was carried out in 30 rats treated by STS, in 30 treated by HPD, and 15 animals were injected with saline. The neurovascular bundle and adjacent muscle were removed at 48 h, 7 and 30 days and examined histologically. I.v. injections of STS produced a solid occlusion of the vein in a significant number of cases, after 30 days (P less than 0.01). A statistically significant number of solid occlusions of the femoral vein resulted after i.v. + p.v. injection of STS and HPD, at 48 h, 7 and 30 days (P less than 0.05; P less than 0.01). There was no significant difference between STS and HPD after i.v. + p.v. injection. After i.v. + p.v. we recorded a marked inflammation of muscle with signs of focal necrosis, at 48 h and 7 days. Our study indicated that i.v. + p.v. injection of STS and HPD provided a high degree of efficacy as regards vein occlusion. On the other hand, i.v. + p.v. injection induced a severe inflammation and necrosis of the tissues surrounding the sclerosed vein. Extrapolating our results to the endoscopic sclerotherapy for esophageal variceal bleeding, we conclude that paravariceal injection of sclerosants is a dangerous procedure, even though efficacious to reduce variceal hemorrhage, owing to the high risk of iatrogenic ulcers and esophageal perforation caused by muscular and mucosal necrosis.

Topics: Animals; Esophageal and Gastric Varices; Female; Femoral Vein; Injections; Injections, Intravenous; Male; Polidocanol; Polyethylene Glycols; Rats; Rats, Inbred Strains; Sclerosing Solutions; Sodium Tetradecyl Sulfate

We report on our two years' experience with the tissue adhesive n-butyl-2-cyanoacrylate. During this period 202 patients suffering from esophagogastric varices were treated endoscopically. With the aid of the tissue adhesive the conventional sclerotherapy with Polidocanol 1% has been clearly improved. Problems concerning early recurrent bleeding and fundic varices are satisfactorily solved. The endoscopic hemostasis of severe variceal bleedings has become safer and surer. The overall hospital mortality of these patients has sunk from 31.5 to 17.5%. Cyanoacrylate is a very useful substance for obliterating large esophagogastric varices. However, the complete elimination of esophageal varices, which is the guarantee for a long-term freedom from recurrent bleeding, can only be achieved by using a genuine sclerosing agent.

Topics: Enbucrilate; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Tissue Adhesives

In 1978, the first Japanese report of sclerotherapy with the flexible esophagoscope was published. At the Second Meeting of the Japanese Society of Sclerotherapy for Esophageal Varices (August 1986), reports were given on over 4000 cases treated by over 70 groups of endoscopists using various methods and sclerosants. These cases included 15 (about 0.4%) in which esophageal perforation occurred, and other complications, some fatal, were also reported. The main problem is to reduce the frequency of these serious complications. Over 400 cases have been treated by the authors in the past 3 years with a method involving consecutive injections of anhydrous ethanol when it is certain that the needle is in the varices. If there is any possibility of the needle being dislocated, 3-5 ml 1% polydocanol is administered instead. Weekly injections should be repeated until all varices have been sclerosized. No major complications have been observed, and the results are satisfactory [7].

Topics: Esophageal and Gastric Varices; Esophagoscopy; Ethanol; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Thrombin

Topics: Blood Coagulation; Blood Coagulation Tests; Esophageal and Gastric Varices; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Topics: Drug Evaluation; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Injections; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

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

During a three-year period 145 consecutive patients with bleeding from oesophageal varices underwent immediate endoscopic sclerotherapy, by para- or intra- and paravascular injection of 4-40 ml 0.5% polidocanol. If the bleeding was not stopped within 15 minutes, a Linton-Nachlas tube was introduced. In case of bleeding recurrences from gastric varices or oesophageal ulcerations a gastro-oesophageal disconnection (after Hassab-Paquet) was performed as an emergency measure or electively. During the bleeding-free interval shunt criteria were examined and, if positive, an elective shunt operation was recommended. Hospital mortality was 16.5%, overall mortality during the period of the study was 29.5%. The results indicate that immediate sclerotherapy of bleeding oesophageal varices improves the prognosis, but it should be undertaken only in centres equipped for emergency endoscopy by an experienced immediately available team.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Endoscopy; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Infant; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Time Factors

A prospective evaluation of sclerotherapy for bleeding esophageal varices has been conducted in 50 unselected consecutive patients. According to Child's classification, 36% were class A, 34% class B and 30% class C. Sclerotherapy was performed on an emergency basis in 22 patients and was delayed a few hours for the others. The aim of the technique was to obliterate the varices by intra- and paravariceal injections of polidocanol 1%. Injections were performed weekly for the first 3 weeks of treatment, then 3- or 6-monthly. Four patients had a severe recurrent hemorrhage during the first month. The mortality during that period was 12%. Follow-up was possible in 81% of the surviving patients. Four stenoses were treated by dilatation. Four patients had a late-recurring hemorrhage which was easily controlled in 3. Four patients died later, 3 of liver insufficiency and one of hemorrhage.

Topics: Adult; Aged; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Rupture, Spontaneous; Sclerosing Solutions

Topics: Adolescent; Age Factors; Child; Child, Preschool; Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Time Factors

The treatment of portal hypertension in children by portosystemic shunt or Vosschulte dissection-ligature is not definitive. Recurrent oesophageal varices or high gastrointestinal bleeding occur on a medium-term and long-term basis. We are investigating endoscopic sclerotherapy as a therapeutic alternative. The aim of this prospective study is to analyse the treatment and follow-up of 7 children with prehepatic portal hypertension who have undergone sclerotherapy, using a flexible endoscope. The first results at short-term and medium-term follow-up are encouraging. The authors discuss the technique, complications and emergency use of sclerotherapy.

Topics: Adolescent; Child; Esophageal and Gastric Varices; Esophagoscopy; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Male; Polidocanol; Polyethylene Glycols; Recurrence

On the occasion of 35 episodes of oesophageal injection therapy in which partly the intravascular and partly the perivascular injection technique were used, real time sonographic measurements were performed on the veins of the portal system immediately before and after sclerotherapy. In the case of intravascular injection, both the portal and the splenic vein and the confluens of the splenic and the superior mesenteric vein showed an increase in diameter, whereas in the cases of perivascular injection such changes were minimal or absent. The practical applicability of such sonographic calibrations could possibly lie in certain conclusions that could be drawn concerning the degree of vascular compression or obliteration during each session of sclerotherapy.

Topics: Esophageal and Gastric Varices; Esophagoscopy; Female; Humans; Liver Cirrhosis; Male; Mesenteric Veins; Middle Aged; Polidocanol; Polyethylene Glycols; Portal Vein; Splenic Vein; Ultrasonography

Acid gastroesophageal reflux was determined by long-term pH monitoring in 19 consecutive variceal bleeders after 5 to 20 (mean, 10.3 +/- 1 SEM) sclerotherapy sessions with the flexible endoscope using polidocanol 1% as sclerosant. Fifteen cirrhotics with untreated varices served as controls. Percentage time of esophageal pH less than 4 (3.3 +/- 0.7 SEM vs. 5.2 +/- 2.2 in the controls) and mean duration of reflux episodes (2.9 +/- 0.4 vs. 3.0 +/- 0.7 min) showed no significant differences between both groups. The findings indicate that repeated injection sclerotherapy with the flexible endoscope does not lead to an enhancement of acid gastroesophageal reflux.

Topics: Esophageal and Gastric Varices; Female; Follow-Up Studies; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Topics: Aged; Esophageal and Gastric Varices; Female; Heart Failure; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Topics: Adolescent; Adult; Child; Child, Preschool; Endoscopy; Esophageal and Gastric Varices; Female; Humans; Injections; Male; 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

43 patients with acute bleeding oesophageal varices were treated by means of endoscopic sclerotherapy using a modified fiber-endoscopic technic by either intravasal or combined intra- and paravasal injections. The results obtained in this group were compared with a group of 30 patients who had been treated conservatively--above all using a Sengstaken tube. According to previous experiences the method proved sufficient. In the sclerotherapy group there were by far less recurrent variceal haemorrhages (22 episodes of haemorrhages in 35 per cent of the patients) than in the control group, and during an average observation time of 16 months 18 per cent of the patients died. On the other hand, in the group treated conservatively, there were 44 episodes of haemorrhages in 60 per cent of the patients and 66.6 per cent of the patients died within 13 months. The results are compared with the results in literature and they suggest that, apart from the decrease of the frequency of haemorrhagic recidivations the sclerotherapy may have a favourable influence on the survival time of patients with liver cirrhosis. These findings, however, must still be confirmed by long-term results.

Topics: Esophageal and Gastric Varices; Esophagoscopes; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions

Topics: Adolescent; Adult; Endoscopy; Esophageal and Gastric Varices; Esophagus; Female; Gastrointestinal Hemorrhage; Humans; Intubation; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Vasopressins

From 1980 to 1984 fortyeight children with portal hypertension were treated, 37 out of these had a prehepatic bloc. In 19 children a sclerotherapy was performed. Seven times a bleeding recurrency occurred and an esophageal stenosis was seen in 2 cases. The distal splenorenal shunt (Warren) was performed 16 times. All children survived, one pneumonia and one slight pancreatitis were observed post-operatively. Four times a shunt obstruction was found at follow-up examinations. Bleeding recurrencies did not appear.

Topics: Child; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Function Tests; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Splenorenal Shunt, Surgical

Fiberendoscopic paravasal sclerotherapy of esophageal varices with Polidocanol at concentration of 1%, is a palliative therapy of a serious sickness. Due to the location of esophageal varices, paravasal sclerotherapy with all its alteration of the esophageal wall takes place in the lower third with its lower sphincter. Twenty middle-aged patients, both sex, with esophageal varices (stadium II-IV due to Paquet) underwent clinical, endoscopic and esophagomanometric control after completion of sclerotherapy. By reaching the therapeutic goal--the subepithelial layers--no pathologic change of the motility of the esophagus has been seen.

Topics: Adult; Aged; Esophageal and Gastric Varices; Esophagogastric Junction; Female; Humans; Male; Middle Aged; Movement; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Topics: Endoscopy; Esophageal and Gastric Varices; Heart Failure; Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols

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

A patient is described who developed severe retrosternal pain and dysphagia immediately after sclerotherapy of esophageal varices. Extensive submucosal bleeding of the esophageal wall was demonstrated radiologically and endoscopically. This lesion resolved within 2 weeks of conservative treatment.

Topics: Adult; Esophageal and Gastric Varices; Esophageal Diseases; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Polidocanol; Polyethylene Glycols; Radiography; Sclerosing Solutions

Topics: Adult; Aged; Aorta, Thoracic; Aortic Aneurysm; Aortic Diseases; Aortic Rupture; Aortitis; Esophageal and Gastric Varices; Female; Humans; Male; Middle Aged; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

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

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

Topics: Esophageal and Gastric Varices; Esophageal Perforation; Female; Humans; Middle Aged; Polidocanol; Polyethylene Glycols

Sclerosing varices of the lower esophagus by endoscopic injection of phenol-peanut oil or ethoxysclerol into the submucosal tissue induces inflammatory changes of varying degree. The process of inflammation leads to formation of connective tissue surrounding and protecting the varices, or to obliteration of these vessels. Phenol-peanut-oil induces a rather mild inflammatory process which contains many macrophages and runs a slow course, leading to fibrosis and sclerosis without complications worth mentioning. Ethoxysclerol on the other hand can induce suppurating, almost phlegmonous inflammation; complications like mediastinitis and pleural exsudates are definitively more common than after injection of phenol-peanut oil. Life threatening situations and death may occur after previous treatment by balloon compression and subsequent sclerosing procedures. Therefore, treatment of esophageal varices by sclerosing procedures should only be done, if the esophageal wall has not been altered by mechanical therapeutic measures.

Topics: Esophageal and Gastric Varices; Esophagus; Gastrointestinal Hemorrhage; Humans; Oils; Peanut Oil; Phenols; Plant Oils; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

With the combined peri- and intravascular sclerosing technique esophageal varices can be completely eliminated in an average of three treatment sessions. In order to check the success of the procedure, endoscopic and histological findings at the various stages of treatment after sclerosing with 1% Polidocanol were compared. Clinical and autopsy findings are in agreement. After sclerosing, necroses of the mucosa and intramural inflammations occur regularly in the first week. The varices are thrombosed. Later, the inner wall of the esophagus is cicatricially changed. Histologically the fibroses extend transmurally and in some parts even reach the musculature.

Topics: Adolescent; Adult; Aged; Child; Esophageal and Gastric Varices; Esophagoscopy; Esophagus; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

The significance of serious complications after endoscopic sclerotherapy is growing alone with the increasing popularity of this method. In a consecutive prospective series of 91 patients with massive haemorrhage from oesophageal varices, treated with fiberendoscopic injection sclerotherapy, four cases of oesophageal necrosis and rupture were encountered.

Topics: Adult; Endoscopy; Esophageal and Gastric Varices; Esophageal Perforation; Esophagus; Fiber Optic Technology; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Topics: Adult; Aged; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Topics: Esophageal and Gastric Varices; Follow-Up Studies; Humans; Polidocanol; Polyethylene Glycols; Recurrence

In order to elucidate pulmonary changes after sclerotherapy of esophageal varices animal experiments were performed. Polidocanol was injected into the submucosa of the distal esophagus and into a branch of the pulmonary artery. The submucous infiltration of the lower esophagus often causes congestive pulmonary alterations near the injection area. The subsequent disturbances of gas exchange as well as the negative inotropic effect of Polidocanol demands therapy in a number of cases.

Topics: Animals; Dogs; Esophageal and Gastric Varices; Female; Lung; Lung Diseases; Male; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Endoscopic sclerosing of oesophageal varices is only a palliative measure, which should be performed when the bleeding came to a standstill. The aim of treatment is to sclerose all visible varices in the oesophagus. This can be done with intervals in 4 to 5 weeks. Anaesthesia is not necessary. We observed perforations in 1%, stenosis of the oesophagus in 10% (n = 414 cases), treated in the last 4 years. The results obtained until now confirm our impression that, at present, injection sclerotherapy is the method of choice.

Topics: Adolescent; Adult; Aged; Child; Esophageal and Gastric Varices; Esophagoscopy; Female; Fiber Optic Technology; Germany, West; Humans; Male; Methods; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Thirteen patients with acute or recent bleeding from gastro-oesophageal varices were treated by sclerotherapy using flexible fiberoptic endoscope. Primary haemostasis was obtained in 10 of 11 admissions with active bleeding. Three patients have been treated for gastric varices with the same method. Such treatment has not been reported before. During the follow-up period, three patients died, two of variceal haemorrhage and one of pneumonia. Ten patients are still alive 2-53 months after the first admission. A total of 117 treatment courses were given, on an average 9 per patient. Complications included superficial mucosal necrosis without clinical consequences in several cases, 3 patients developed oesophageal and gastric ulcers and one moderate oesophageal stenosis. Rebleeding occurred in 4 patients, in 2 of them because of ulcers at the sites of injections.

Topics: Adolescent; Adult; Aged; Child; Endoscopy; Esophageal and Gastric Varices; Female; Fiber Optic Technology; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Stomach; Varicose Veins

Forty-one patients with hepatic cirrhosis of alcoholic etiology and esophageal varices were subjected to endoscopic sclerotherapy. Four patients were treated during the intervals between hemorrhages; thirty after their first hemorrhage and 7 prophylactically. Propranolol was administered to 5 patients, in doses of 60-80 mg daily. The survival rate for a period of 5 to 16 months was 83%. No complications attributable to the procedure were observed.

Topics: Endoscopy; Esophageal and Gastric Varices; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis, Alcoholic; Polidocanol; Polyethylene Glycols; Propranolol; Recurrence

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

Topics: Adult; Aged; Endoscopy; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Methods; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Autopsies were performed on 53 patients with oesophageal varices treated with ethoxysclerol to effect sclerosis of the terminal oesophageal wall. The morphological changes after perivascular injection, disturbance of wound healing and complications are described. In 20 cases it was possible to follow the various stages of the normal resorptive inflammatory reaction with transition to perivascular sclerosis of the oesophageal wall. Fatal complications tended to arise in cases with an existing oesophageal lesion produced by the mechanical action of an oesophageal tube. Deeply penetrating mucosal ulcers, perforation of the wall and phlegmonous inflammation leading to mediastinitis were observed in almost 75% of the cases. The results of this morphological analysis might be used as a basis for a prospective morphological study of patients with varices treated with oil-containing solutions injected into the oesophageal wall.

Topics: Esophageal and Gastric Varices; Esophagus; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions