polidocanol and Gastrointestinal-Hemorrhage

Topics: Anemia; Child; Duodenum; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Humans; Injections, Intralesional; Nevus, Blue; Polidocanol; Sclerosing Solutions; Sclerotherapy; Skin Neoplasms; Treatment Outcome; Vascular Malformations

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

To investigate the effectiveness of prophylactic injection therapy in vascular malformations after acute hemorrhage. To review recent advances in diagnosis and treatment control of bleeding intestinal angiodysplasias with an endoscopic Doppler device.. Open prospective study involving 34 patients with bleeding from gastroduodenal and colorectal angiodysplasias.. In order to detect the superficial arterial vessels responsible for the bleeding, a total of 79 lesions were scanned by transendoscopic Doppler ultrasonography. 70 vascular ectasias (88.6%) were Doppler-positive and had injection therapy with epinephrine and polidocanol.. Out of the 70 sclerosed angiodysplasias, 63% (90.0%) could not be found endoscopically 2 weeks later, confirming the success of therapy. Doppler noise was still recorded in 7 visible malformations, indicating insufficient treatment. Further injections were made into these lesions, and the vascular anomalies were finally eliminated. During 1 year of follow-up, 2 of the 34 treated patients (5.88%) relapsed with actively bleeding cecal angiodysplasias. After repeated endoscopic hemostasis, no more hemorrhage was observed in both patients. The results were partly published in previous publications.. Endoscopic Doppler ultrasonography may help in identification and treatment of intestinal angiodysplasias. The technically simple method allows objective evaluation of the endoscopic findings and enables monitoring of local endoscopic therapy.

Topics: Adult; Aged; Aged, 80 and over; Angiodysplasia; Epinephrine; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerotherapy; Ultrasonography, Doppler

Two cases of bleeding gastric angiodysplasia treated with a different approach, on the basis of the endoscopic features, are reported. Arteriovenous malformations may arise from any site of the digestive tract: gastric angiodysplasia represents one of the less frequent localizations, causing 2-5% of upper gastrointestinal bleeding. Several diagnostic tools are currently available and the choice of the most appropriate therapeutic strategy depends on many features: site and number of the lesions, patient's hemodynamic conditions, endoscopic skill. Surgery is preferred only when multiple and disseminated lesions within the gastric wall occur or when endoscopic approach fails.

Topics: Angiodysplasia; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Stomach; Stomach Diseases

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

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

Management of Haemorrhoids is suboptimal and is largely based on traditional practices in the Indian population. Though injection sclerotherapy is a well-accepted treatment modality in early grade haemorrhoids, there is no consensus on the effectiveness of the drugs used for sclerotherapy. The study was done to compare the safety and efficacy of a standard sclerosant (polidocanol) and the conventionally used phenol in oil in bleeding grade-1 and 2 internal haemorrhoids.. All patients with grade-1 and 2 hemorrhoids, were selected and randomised into two groups, 3% polidocanol and 5% phenol group. All patients were followed-up for three months and observed for "free of bleeding" or "persistent bleeding." Pain, pruritus and patient satisfaction following the procedure was also assessed.. A total of 150 patients were enrolled, 75 in each group. At the end of the first sclerotherapy session with polidocanol, 60.6% of patients versus 38.1% in phenol group had stopped per rectal bleeding (p=0.009). After the second sclerotherapy session, 94.7% of patients in the polidocanol group and 84% of patients in the phenol group were treated successfully. Polidocanol group required significantly fewer treatment sessions than the phenol group (1.39±0.49 vs. 1.62±0.49; p=0.035), and the total volume of injected sclerosant was also less (3.30±0.96 mL vs. 4.86±1.46 mL; p=0.001). The patient satisfaction was 87% in polidocanol group versus 73% in phenol group (p=0.040).. 3% polidocanol is safe and more effective than 5% phenol in oil when used as injection sclerotherapy in the treatment of first and second-degree internal hemorrhoids.

Topics: Adult; Female; Gastrointestinal Hemorrhage; Hemorrhoids; Humans; Male; Middle Aged; Phenol; Polidocanol; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

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

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

To investigate the endoscopic hemostasis for gastrointestinal bleeding due to Dieulafoy's lesion.. One hundred and seven patients with gastrointestinal bleeding due to Dieulafoy's lesion were treated with three endoscopic hemostasis methods: aethoxysklerol injection (46 cases), endoscopic hemoclip hemostasis (31 cases), and a combination of hemoclip hemostasis with aethoxysklerol injection (30 cases).. The rates of successful hemostasis using the three methods were 71.7% (33/46), 77.4% (24/31) and 96.7% (29/30), respectively, with significant differences between the methods (P < 0.05). Among those who had unsuccessful treatment with aethoxysklerol injection, 13 were treated with hemoclip hemostasis and 4 underwent surgical operation; 9 cases were successful in the injection therapy. Among the cases with unsuccessful treatment with hemoclip hemostasis, 7 were treated with injection of aethoxysklerol and 3 cases underwent surgical operation; 4 cases were successful in the treatment with hemoclip hemostasis. Only 1 case had unsuccessful treatment with a combined therapy of hemoclip hemostasis and aethoxysklerol injection, and surgery was then performed. No serious complications of perforation occurred in the patients whose bleeding was treated with the endoscopic hemostasis, and no re-bleeding was found during a 1-year follow-up.. The combined therapy of hemoclip hemostasis with aethoxysklerol injection is the most effective method for gastrointestinal bleeding due to Dieulafoy's lesion.

Topics: Adult; Aged; Arteriovenous Malformations; Endoscopy; Female; Gastrointestinal Hemorrhage; Gastroscopy; Hemostasis, Endoscopic; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols

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

Endoscopic injection is widely used in the therapy of bleeding gastroduodenal ulcers, but its role in the management of bleeding Mallory-Weiss tears has not been properly assessed.. Sixty-three patients undergoing emergency endoscopy in whom there was a high index of suspicion that a Mallory-Weiss tear was the source of bleeding were randomly assigned to undergo endoscopic injection therapy (epinephrine and polidocanol) or no endoscopic therapy in 2 university-affiliated hospitals. Rates of recurrent bleeding, transfusion requirements, complications, mortality, and length of hospital stay were determined for both groups of patients.. Bleeding recurred in 8 patients in the control group versus only 2 in the endoscopic treatment group (25.8% vs. 6.2%, p < 0.05). Hospital stay was longer for the control group (5.5 +/- 0.2, median 6.0, range 2.0-8.0 days vs. 3.4 +/- 0.2, median 3.0, range 2.0-6.0 days; p < 0.001). There was a trend toward a higher transfusion requirement after endoscopy in the control group versus the patients treated by injection (0.9 +/- 0.2, median 0.0, range 0.0-4.0 units vs. 0.2 +/- 0.1, median 0.0, range 0.0-2.0 units; p = 0.09). No complications or adverse events caused by endoscopic injection were noted. Two patients in the control group died of causes unrelated to bleeding.. Endoscopic injection therapy is a useful option in the management of patients with Mallory-Weiss syndrome at high risk for recurrent bleeding.

Topics: Epinephrine; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Gastroscopy; Hemostatic Techniques; Humans; Injections, Intralesional; Male; Mallory-Weiss Syndrome; Middle Aged; Polidocanol; Polyethylene Glycols; Probability; Reference Values; Treatment Outcome

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

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

The experience in therapeutic digestive endoscopy is presented using injection technique with adrenalin-polidocanol of gastrointestinal hemorrhage lesions. One hundred and twenty nine patients were treated endoscopically; the medium age was 60 years; in almost 80% of the cases, peptic ulcer disease were found. The effectiveness was 91.4% when one session procedure was used and in some cases two sessions were applied, giving a final total arrest of hemorrhage of 95.3%. The total mortality still remain high (16.3%) even without bleeding, due to coexisting poor general conditions of the patients. The technique of endoscopic injection is reviewed and the final results of our work are presented.

Topics: Adult; Aged; Aged, 80 and over; Endoscopy, Gastrointestinal; Epinephrine; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Recurrence; Sclerosing Solutions; 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

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

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

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

The management of hemorrhoidal disease (HD) in patients with bleeding disorders (BD) is challenging. Polidocanol foam sclerotherapy (PFS) is associated with a low rate of bleeding complications. The aim of this study was to compare the efficacy and safety of PFS in the treatment of HD in patients with and without BD.. This prospective, multicenter, cohort study enrolled patients with (group B) and without (group A) BD, with symptomatic internal HD grades I-III over an 18-month period. All patients were treated with PFS. Patients with congenital BD did not undergo prior replacement therapy and those with acquired BD due to antithrombotic drugs, did not discontinue therapy. Efficacy outcomes included therapeutic success and HD recurrence during a 1-year follow-up period. To evaluate safety the complications related to PFS were recorded.. We included 228 patients (group A: 155, group B: 73; male/female: 114/114; mean age: 59.4 ± 15.9 years). The baseline hemorrhoidal disease bleeding grade (p < 0.001) and Sodergren hemorrhoidal symptom severity score (p = 0.019) were higher for group B. The overall therapeutic success rate was 93.4% with an average number of sessions of 1.51 ± 0.74, significantly higher for group B (1.68 ± 0.86 vs 1.43 ± 0.65, p = 0.013). Complications occurred in 11.4% of the patients, with bleeding reported in 4.8%. The majority of complications were mild (96.2%). No significant differences between the two groups were observed for therapeutic success, recurrence, or complication rate.. Patients with BD may have more symptomatic HD at baseline. Even so, PSF showed similar effectiveness and safety in patients with BD compared to patients without BD.

Topics: Adult; Aged; Cohort Studies; Female; Gastrointestinal Hemorrhage; Hemorrhoids; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome

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: 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

Topics: Aged, 80 and over; Arterioles; Endosonography; Epinephrine; Gastric Fundus; Gastrointestinal Hemorrhage; Gastroscopy; Hemostasis, Endoscopic; Humans; Injections, Intralesional; Male; Polidocanol; Recurrence; Sclerosing Solutions; Sclerotherapy

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors involving the gastrointestinal tract. A small percentage of GISTs may cause acute gastrointestinal bleeding, which requires urgent surgical intervention.. In this case report, we present a 62-year-old male patient with who was hospitalized due to acute bleeding.. The patient was diagnosed as GIST with low risk.. The patient was treated endoscopically with polidocanol sclerotherapy.. The mass was removed completely, and the patient was discharged at day 9 after operation.. This case indicates that GIST can present as massive upper gastrointestinal bleeding and urgent endoscopic sclerotherapy can be life-saving. The endoscopical intervention may be a good alternative for emergency.

Topics: Gastrointestinal Hemorrhage; Gastrointestinal Neoplasms; Gastrointestinal Stromal Tumors; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy

The term angiodysplasia (AD) refers to acquired malformation of the blood vessels (communications between veins and capillaries), frequently found within the gastrointestinal mucosa and submucosa. AD of stomach and duodenum are cause of upper gastrointestinal bleeding in 4%-7% of patients. The means of treatment are usually endoscopic, including argon plasma coagulation (APC), electrocoagulation, mechanical hemostasis by clippsing, laser photo-coagulation and injection therapy.. To compare the success rate, and adverse events (ulcer lesions, perforations) of APC and injection therapy in the treatment of bleeding angiodysplasia in the upper gastrointestinal tract (GIT).. In a prospective study including 50 patients with bleeding angiodysplasia of the upper GIT, 35 patients were treated with APC, and remaining 15 with injection therapy using adrenaline and 1.5% solution of polidocanol. Follow-up period was 6 months.. A total of 50 patients aged 18 to 64 years, 64% male and 36% female, have been treated during 2 years period. The rate of recurrent bleeding and side effects was significantly higher in the adrenaline group (p <0.01). Blood transfusion was required in 68% during the first hospital admission. Angiodysplasia of the stomach was present in 66%, versus 34% in duodenum.. Endoscopy is "gold standard" for diagnosis and treatment of AD in the gastrointestinal tract. The study unveiled APC as more effective treatment option with lower degree of complications and adverse events in comparison to injection therapy in patients with bleeding AD.

Topics: Adult; Angiodysplasia; Argon Plasma Coagulation; Blood Transfusion; Endoscopy, Gastrointestinal; Epinephrine; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Male; Middle Aged; Polidocanol; Prospective Studies; Sclerosing Solutions; Treatment Outcome; Upper Gastrointestinal Tract; Young Adult

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

Small-bowel hemangioma is a rare disease that often causes active bleeding. The standard therapeutic method for small-bowel hemangioma is surgical resection. The aim of this study was to evaluate the usefulness of polidocanol injection (PDI) for small-bowel hemangiomas.. This study included 12 patients with obscure GI bleeding (6 male; mean age 62 years) with 39 small-bowel hemangiomas; patients were treated with PDI by using double-balloon endoscopy (DBE). EUS with DBE was performed before PDI. The lesions were divided into 2 groups according to tumor size: Group A (size <10 mm; 20 lesions) and group B (size ≥10 mm; 19 lesions). The outcomes of PDI treatment for small-bowel hemangioma were evaluated between the 2 groups. Additionally, in order to standardize the amount of PDI injected, the total amount of polidocanol according to lesion size was calculated.. There was no difference in the location of lesions and treatment times between the 2 groups. Group B had a significantly higher injection time per lesion (P < .05) and amount of polidocanol per lesion than group A (P < .01). Rebleeding occurred in only 1 case (8%). There were no adverse events related to PDI. The contribution ratio between the lesion size and amount of polidocanol showed a correlation (r = 0.77). The optimal amount of polidocanol for small-bowel hemangioma was determined to be 0.2 mL/mm.. PDI is an easy, safe, and effective method to treat small-bowel hemangiomas.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Double-Balloon Enteroscopy; Female; Gastrointestinal Hemorrhage; Hemangioma; Humans; Ileal Neoplasms; Injections, Intralesional; Jejunal Neoplasms; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Young Adult

Topics: Adult; Gastrointestinal Hemorrhage; Humans; Male; Polidocanol; Polyethylene Glycols; Rectum; Sclerosing Solutions; Sclerotherapy; Veins

EMR is the standard of care for the resection of large polyps.. To compare the efficacy and safety profile of submucosal polidocanol injection with epinephrine-saline solution injection for colon polypectomy with a diathermic snare.. After 1-to-1 propensity score caliper matching, comparison of submucosal epinephrine injection was performed with polidocanol injection.. Endoscopic suite at the University of Foggia between 2005 and 2014.. Of 711 patients who underwent endoscopic resection of colon sessile polyps 20 mm or larger, 612 were analyzed after matching.. Submucosal epinephrine injection in 306 patients and polidocanol injection in 306 patients.. Univariate and multivariate logistic regression models aimed at identifying independent predictors of postpolypectomy bleeding (PPB).. The 2 groups presented similar baseline clinical parameters and lesion characteristics. All patients had a single polyp 20 mm or larger; the median size was 32 mm (interquartile range [IQR], 25-38) in the polidocanol group and 32 (IQR, 24-38) in the epinephrine group (P=.7). Polidocanol was more effective in preventing both immediate and delayed PPB (P<.001 and P=.003, respectively), and its efficacy was confirmed in almost all of the subgroups, regardless of polyp size and histology. Postprocedure perforation was observed in 2 patients (0.3%), both in the epinephrine group (P=.49). The 2 groups did not differ in the number of snare resections of lesions or the procedure duration (P=.24 and .6, respectively).. Absence of randomization.. The submucosal injection of polidocanol for colon EMR is effective and significantly lowers the PPB rate.

Topics: Aged; Blood Loss, Surgical; Colonic Polyps; Colonoscopy; Epinephrine; Female; Gastrointestinal Hemorrhage; Humans; Injections; Intestinal Perforation; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Postoperative Hemorrhage; Propensity Score; Retrospective Studies; Sclerosing Solutions; Vasoconstrictor Agents

Small-bowel angioectasias are frequently diagnosed with capsule endoscopy (CE) or balloon endoscopy however, major predictors have not been defined and the indications for endoscopic treatment have not been standardized. The aim of this study was to evaluate the predictors and management of small-bowel angioectasia.. Among patients with obscure gastrointestinal bleeding (OGIB) who underwent both CE and double-balloon endoscopy at our institution, we enrolled 64 patients with small-bowel angioectasia (angioectasia group) and 97 patients without small-bowel angioectasia (non-angioectasia group). The angioectasia group was subdivided into patients with type 1a angioectasia (35 cases) and type 1b angioectasia (29 cases) according to the Yano-Yamamoto classification. Patient characteristics, treatment, and outcomes were evaluated.. Age (P = 0.001), cardiovascular disease (P = 0.002), and liver cirrhosis (P = 0.003) were identified as significant predictors of small-bowel angioectasia. Multivariate logistic regression analysis identified cardiovascular disease (odds ratio 2.86; 95% confidence interval, 1.35-6.18) and liver cirrhosis (odds ratio 4.81; 95% confidence interval, 1.79-14.5) as independent predictors of small-bowel angioectasia. Eleven type 1a cases without oozing were treated conservatively, and 24 type 1a cases with oozing were treated with polidocanol injection (PDI). Re-bleeding occurred in two type 1a cases (6%). Seventeen type 1b cases were treated with PDI and 12 type 1b cases were treated with PDI combined with argon plasma coagulation (APC) or clipping. Re-bleeding occurred in five type 1b cases (17%) that resolved after additional endoscopic hemostasis in all cases. There was one adverse event from endoscopic treatment (1.6%).. Cardiovascular disease and liver cirrhosis were significant independent major predictors of small-bowel angioectasia. Type 1a angioectasias with oozing are indicated for PDI and type 1b angioectasias are indicated for PDI with APC or clipping.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Angiodysplasia; Argon Plasma Coagulation; Capsule Endoscopy; Cardiovascular Diseases; Double-Balloon Enteroscopy; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Intestinal Diseases; Intestine, Small; Liver Cirrhosis; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Risk Factors; Sclerosing Solutions; Young Adult

Gastric antral vascular ectasia (GAVE) is an uncommon disorder observed in patients with liver cirrhosis, causing upper gastro-intestinal haemorrhage. GAVE is diagnosed through esophagogastroduodenoscopy and is characterized by the presence of visible columns of red tortuous enlarged vessels along the longitudinal folds of the antrum (i.e., so-called watermelon stomach). Pharmacological, endoscopic and surgical approaches have been proposed for the treatment of GAVE. Endoscopy represents the gold standard for GAVE treatment. The most widely used endoscopic approach is represented by Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Argon plasma coagulation (APC) has been proven to be more efficient in terms of costs and complication rates than and equally effective as Nd:YAG. Other endoscopic procedures proposed for this treatment are banding ligature (EBL) and sclerotherapy with Polidocanol. Refractory GAVE represents a therapeutic challenge because it may cause persistent anemia, often leading to repeated blood transfusions due to the inefficacy of pharmacological and endoscopic therapeutic approaches. Endoscopic band ligation (EBL) has been shown to be superior to APC in the treatment of refractory GAVE. Surgical antrectomy by Billroth I anastomosis can be considered in selected cases. In this study, we report a successful endoscopic treatment of refractory GAVE by using a combination of submucosal injection of 1% Polidocanol at the four antral quadrants and subsequent application of APC on the visible antral lesions in two patients.

Topics: Aged; Argon Plasma Coagulation; Endoscopy, Gastrointestinal; Female; Gastric Antral Vascular Ectasia; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Polidocanol; Polyethylene Glycols; Sclerotherapy; Treatment Outcome

Recent developments in therapeutic endoscopic ultrasound (EUS) have enabled new approaches to the management of refractory gastrointestinal bleeding, including EUS-guided sclerotherapy and vessel embolization. Few cases have been reported in the literature. Eight patients were admitted for severe, refractory gastrointestinal bleeding, seven of whom were actively bleeding. Causes of bleeding were gastric varices secondary to portal hypertension (n = 3); gastroduodenal artery aneurysm or fundal aneurysmal arterial malformation (n = 3); and Dieulafoy's ulcer (n = 2); the latter five patients having arterial bleeding. During the procedures, the bleeding vessel was punctured with a 19-gauge needle then injected with a sclerosing agent (cyanoacrylate glue [n = 6] or polidocanol 2 % [n = 2]) under Doppler control. The median follow-up time was 9 months (3 - 18 months). In all 10 endoscopic procedures were performed. The procedure was successful at the first attempt in seven out of eight patients (87.5 %). No clinical complications were observed, although in one case there was diffusion of cyanoacrylate in the hepatic artery. The seven successful cases all showed immediate and complete disappearance of the Doppler flow signal at the end of the procedure. This retrospective study highlights the utility of EUS-guided vascular therapy. However, more large randomized studies should be conducted to confirm these results.

Topics: Aged, 80 and over; Cyanoacrylates; Endoscopy, Gastrointestinal; Endosonography; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Injections, Intra-Arterial; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Tissue Adhesives; Ultrasonography, Interventional

Topics: Argon Plasma Coagulation; Arterioles; Arteriovenous Malformations; Duodenum; Female; Gastrointestinal Hemorrhage; Gastroscopy; Hemostasis, Endoscopic; Humans; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Treatment Outcome; Young Adult

Topics: Anemia; Colonoscopy; Endoscopy, Digestive System; Gastrointestinal Hemorrhage; Humans; Iron; Jejunum; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerotherapy; Varicose Veins

Topics: Acenocoumarol; Adenocarcinoma; Anticoagulants; Biopsy, Needle; Colonoscopy; Epinephrine; Erythrocyte Transfusion; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Hemostatics; Heparin, Low-Molecular-Weight; Humans; Hypotension; Male; Polidocanol; Polyethylene Glycols; Prostate; Prostatic Neoplasms; Rectal Diseases; Rectum; Sclerosing Solutions

Topics: Aged, 80 and over; Anal Canal; Argon Plasma Coagulation; Capsule Endoscopy; Colonoscopy; Comorbidity; Epinephrine; Gastrointestinal Hemorrhage; Humans; Ligation; Male; Polidocanol; Polyethylene Glycols; Rectum; Recurrence; Sclerotherapy; Suture Techniques; Vascular Malformations

Topics: Aged; Drug Therapy, Combination; Duodenal Neoplasms; Endosonography; Epinephrine; Female; Gastrointestinal Hemorrhage; Humans; Neurofibromatosis 1; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Treatment Outcome; Vasoconstrictor Agents

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

Early upper GI hemorrhage (UGH) is a potential complication after laparoscopic Roux-en-Y gastric bypass (RYGBP), and early reoperative intervention is the most accepted treatment. Experience with endoscopic treatment is limited.. Our purpose was to describe the role of endoscopy and injection therapy in the management of early UGH after laparoscopic RYGBP.. Case series study.. Endoscopy Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.. We describe the endoscopic treatment of 6 patients with early UGH within 24 hours after a RYGBP.. Upper endoscopy was performed in all 6 cases. The origin of the bleeding was identified at the staple line in all cases, and epinephrine alone or combined with polidocanol was successfully injected in 5 of 6 patients.. Endoscopic therapy arrested active bleeding without any complications in all cases without the need for further surgery or endoscopic treatments.. Our experience is limited to 6 cases.. Early postoperative UGH after RYGBP may be adequately controlled with endoscopic treatment and may obviate the need for surgery. Further data are necessary to evaluate the safety and the efficacy of this approach.

Topics: Adult; Cohort Studies; Endoscopy, Gastrointestinal; Epinephrine; Female; Gastric Bypass; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Laparoscopy; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Treatment Outcome; Vasoconstrictor Agents

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

A 72-year-old man with acute myelocytic leukemia (AML) suffered relapsing massive bleeding from gastric angiodysplasia. He was referred to our hospital in February 2000 because of anemia and thrombocytopenia. He had hypercellular (nucleated cell count 42 x 10(4)/microl) bone marrow with 90% myeloblasts, and AML (FAB: M1) was diagnosed. Remission induction therapy by BHAC/DM regimen failed. While considering subsequent regimens, massive hematemesis from a solitary gastric angiodysplasia developed. In April, after re-remission induction by CAG regimen, hematemesis from the same lesion reccurred. Hemostasis was achieved by topical transendoscopic injection of polidocanol. After achievement of complete remission by CAG therapy, he was treated on an outpatient basis. In July, his AML relapsed and he was treated mainly by transfusion therapy. In September, hematemesis recurred resulting in hemostasis with the same procedure. In the course of endoscopic injections, his mucosal lesion became difficult to observe. Gastric angiodysplasia is occasionally observed in the elderly, but massive bleeding is a rare complication. In this case, topical injection of polidocanol was an effective procedure for the massive bleeding from it even in an elderly patient with the complication of thrombocytopenia due to AML.

Topics: Aged; Angiodysplasia; Endoscopy, Gastrointestinal; Gastrointestinal Hemorrhage; Humans; Injections, Intralesional; Leukemia, Myeloid, Acute; Male; Polidocanol; Polyethylene Glycols; Stomach Diseases

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

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

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

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

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

The clinical histories of 14 patients with digestive hemorrhage due to Dieulafoy disease admitted to the authors' hospital over 74 months were retrospectively analyzed. These cases represent 1.18% of the non varicose upper digestive hemorrhages (CI 95%; 0.57-1.79%). Male predominance (6:1) and advanced age (median: 67.5 years) were observed. The ingestion of potentially gastroerosive drugs, smoking and alcoholism were reported in 57, 57 and 7% of the cases, respectively. Six patients (43%) required more than one endoscopy for diagnosis. The lesion responsible for hemorrhage was found at 6 cm or less from the cardias on 11 occasions (78%). Endoscopic sclerotherapy was performed in the vessel by polidocanol at 2% (1.5-10 ml, median: 6). In 10 cases sclerotherapy was preceded by the injection of adrenaline 1/10,000 (2-11 ml, median: 5). Definitive hemostasis was achieved in 11 patients (78%) (two of these cases required further sclerotherapy); 2 patients required surgery, and one patient (7%) died. Of the 13 surviving patients, none presented relapse after follow up of 2-63 months. We can conclude that Dieulafoy disease is an infrequent but severe cause of digestive hemorrhage, being predominantly found in males over the age of 50 years. Repeated endoscopy is often required to determine diagnosis and treatment. Endoscopic sclerotherapy with polidocanol is effective and safe in this disease although surgery may be required and death may occur.

Topics: Adult; Aged; Aged, 80 and over; Endoscopy; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Intestinal Mucosa; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Stomach Ulcer; Syndrome; Time Factors

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

Topics: Adult; Epinephrine; Female; Gastrointestinal Hemorrhage; Hemostasis, Endoscopic; Humans; Mallory-Weiss Syndrome; Polidocanol; Polyethylene Glycols; Pregnancy; Pregnancy Complications; 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

A 53-year-old man had been passing tarry stools and bright red blood per rectum for 6 days. He had a history of pyloroplasty for duodenal ulcers, alcoholic liver cirrhosis, stage B in Child's classification, a Le Veen shunt for ascites, grade I oesophageal varices and several episodes of intestinal bleeding of uncertain cause on repeated endoscopies. Haemoglobin levels was now 4.4 g/dl. Neither oesophago-gastro-duodenoscopy nor colposcopy, radiological examination of the small intestine nor scintigraphy discovered the source of bleeding. Computed tomography revealed varices in the horizontal part of the duodenum, confirmed by arteriography.. At a second endoscopy, this time with a long scope, acute bleedings were seen in the venous convolutions and stopped with 4 ml Polidocanol. Bleeding recurred after 10 days, thought to be due to persisting portal hypertension. A transjugular intrahepatic portosystemic stent shunt (TIPSS) was inserted to lower the pressure. Colour-coded Doppler examination at the time of another bleeding 10 weeks later demonstrated occlusion of the TIPSS. It was re-opened by balloon catheter dilatation, since when there have been no further episodes of bleeding.. The implantation of a TIPSS is a new causative treatment for recurrent bleeding from ectopic varices due to portal hypertension that cannot be treated by endoscopy.

Topics: Angiography; Duodenoscopy; Duodenum; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Portasystemic Shunt, Surgical; Recurrence; Sclerosing Solutions; Stents; Tomography, X-Ray Computed; Varicose Veins

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

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

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

The findings from 480 patients who had emergency endoscopy for acute upper gastrointestinal bleeding of non-variceal origin at our institution were analysed. Twenty eight patients (5.8%) had a Dieulafoy lesion. In 27 patients (96.4%) bleeding could be successfully managed by injection of norepinephrine and polidocanol, in repeated sessions if needed. Two patients had to be treated surgically: one because of uncontrollable bleeding from the Dieulafoy lesion and one despite endoscopic control of the bleeding Dieulafoy lesion because of a concomitant bleeding from an anastomosal ulcer after gastric resection. Three patients died during hospital stay from causes unrelated to bleeding from Dieulafoy lesion. Out of the 25 patients discharged from the hospital 21 treated by endoscopy and two treated with surgery were followed up for a mean of 28.3 and 22.5 months, respectively. Twenty endoscopically treated patients (95%) had no recurrence of Dieulafoy's bleeding. One patient experienced severe rebleeding from the original site after a transient endoscopy confirmed complete disappearance. He had emergency operation without a further attempt to control bleeding by endoscopy. It is concluded that bleeding from Dieulafoy's disease can be successfully managed by endoscopic injection treatment. The longterm outcome is favourable.

Topics: Adult; Aged; Aged, 80 and over; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Norepinephrine; Polidocanol; Polyethylene Glycols; Prognosis; Sclerosing Solutions; Stomach Diseases

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

In 19 of 532 consecutive patients with intestinal bleeding, 47 vascular malformations were found endoscopically as the source of the hemorrhage (3.6%). Eleven angiodysplasias were located in the gastroduodenum and 36 in the colorectum. In all patients, bleeding had stopped spontaneously before endoscopy was performed. To detect superficial arterial vessels responsible for the hemorrhage all lesions were scanned by transendoscopic Doppler ultrasound. There were 41 Doppler-positive anomalies (87%) and 6 Doppler-negative anomalies without an arterial signal. All malformations with submucosal arterial blood flow were treated by prophylactic injection therapy. Control Doppler ultrasound two weeks later revealed the presence of a vessel in 4 angiodysplasias followed by a second sclerotherapy. The 6 Doppler negative lesions could not be found on control examination and corresponded probably to temporary traumatic or inflammatory mucosal changes. Within the framework of follow-up over three months, 2 patients rebled (10.5%). A second sclerotherapy resulted in no further hemorrhage. Endoscopic Doppler ultrasound may help in identification and treatment of gastrointestinal angiodysplasias. After identification of blood vessels responsible for hemorrhage, Doppler ultrasound enables monitoring of local endoscopic therapy.

Topics: Adult; Aged; Arteriovenous Malformations; Digestive System; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sclerotherapy; Ultrasonics; Ultrasonography

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

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

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

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

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

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

For a duration of three years, endoscopic hemostasis was carried out in the Department for Gastroenterology at the State Hospital of the Canton of St. Gall on 20 patients suffering from acute upper gastrointestinal hemorrhage. 13 cases were of the hemorrhage type Forest IA, seven cases of the type Forest IB. By way of injecting adrenalin and/or Polidocanol, in all cases an initial hemostasis and in 80% of the cases a definite effect was attained. We judge the injection-method to be a simple, effective and inexpensive way of stopping hemorrhage. This method helps to avoid operating on high-risk patients to stop hemorrhage in the upper gastrointestinal parts.

Topics: Adult; Aged; Aged, 80 and over; Esophagitis; Female; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

Emergency esophago-gastro-duodenoscopy was performed in 45 consecutive patients (26 men, 19 women, mean age 64 [23-91] years) with non-varicose upper gastrointestinal bleeding. The bleeding was arrested endoscopically by circumferential injection of an average of 6 (2-10) ml 1% polidocanol solution. In 10 patients an injection treatment was not possible because of extensive erosion or massive arterial bleeding. Bleeding recurred in seven patients 12-48 hours after initial injection. One patient in whom injection was not possible died during operation from massive intractable bleeding from an aortoduodenal fistula after abdominal aorta aneurysm surgery with implantation of a dacron prosthesis. There were no complications of the injection treatment.

Topics: Adult; Aged; Aged, 80 and over; Drug Evaluation; Duodenal Ulcer; Endoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Mallory-Weiss Syndrome; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Recurrence; Sclerosing Solutions; Stomach Ulcer

Topics: Aprotinin; Drug Combinations; Endoscopy; Factor XIII; Fibrin Tissue Adhesive; Fibrinogen; Gastrointestinal Hemorrhage; Humans; Pilot Projects; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Thrombin

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

Excellent clinical results have been reported with sclerotherapy for control of nonvariceal gastrointestinal hemorrhage. However, there are few controlled or comparative data on different sclerosing agents for treatment of lesions with active arterial bleeding or nonbleeding visible vessels. In a controlled, randomized study of canine small bowel arteries our purposes were (a) to evaluate the efficacy for arterial coagulation of six sclerosing agents compared with normal saline control, (b) to compare the resultant tissue injury of agents, and (c) to elucidate the possible mechanisms of arterial coagulation and tissue injury of the agents. The agents evaluated were (a) 98% ethanol, (b) TES, a mixture with final concentration of 1% tetradecyl sulfate, 32% ethanol, and 0.3 normal saline, (c) 1% polidocanol (Ethoxysclerol), (d) 1:10,000 epinephrine, (e) 7.2% hypertonic saline, (f) 3.6% hypertonic saline, and (g) 0.9% saline (normal saline control). Agents were injected from the mucosal side of the small bowel into and around the pentrating serosal arteries in the subserosal space. Ethanol and TES were the most effective agents for arterial coagulation. Polidocanol was less effective than ethanol and TES. However, it was the only other agent that induced significant arterial coagulation. Alcohol and TES also caused significant injury in surrounding tissue. The degree of this injury was dependent on the total volume injected. Epinephrine induced significant mucosal damage without significant serosal injury or arterial coagulation. The coagulation and tissue injury effects of hypertonic saline injections were not significantly different from normal saline control.

Topics: Animals; Arteries; Dogs; Epinephrine; Ethanol; Gastrointestinal Hemorrhage; Intestine, Small; Polidocanol; Polyethylene Glycols; Random Allocation; Saline Solution, Hypertonic; Sclerosing Solutions; Tromethamine

Efficacy and tissue effects of injection therapy for nonvariceal upper gastrointestinal bleeding were studied in 16 mongrel dogs. The results were compared with those obtained by neodymium-yttrium-aluminum-garnet laser, bipolar electrocoagulation, and heater probe. Epinephrine (1:10,000), absolute ethanol, and 1% polidocanol were used as injection solutions. In acute, severely bleeding experimental ulcers as well as in transected submucosal arteries, injection methods were not as effective as thermal methods in achieving complete hemostasis, although injection therapy, especially with large volumes of epinephrine (1:10,000), very quickly decreased the rate of bleeding. Chronic experiments showed that epinephrine (1:10,000) caused almost no tissue injury, but also did not induce vessel thrombosis. In contrast, absolute ethanol and 1% polidocanol caused tissue necrosis, ulceration, and vessel thrombosis, the former by acute dehydration and fixation of the tissue, the latter by acute edema and subsequent inflammation and sclerosis. These data suggest that although epinephrine injection may slow or temporarily stop bleeding, this modality is not as efficacious as injection with 1% polidocanol or absolute ethanol in inducing definitive vessel thrombosis. In the present experimental conditions sclerotherapy was not as effective as thermal methods in achieving hemostasis. These data also show that injection therapy with 1% polidocanol and absolute ethanol is by no means safer than thermal methods.

Topics: Animals; Dogs; Electrocoagulation; Epinephrine; Ethanol; Gastrointestinal Hemorrhage; Light Coagulation; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

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: 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

Topics: Adult; Aged; Endoscopy; Female; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

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

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

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

In a prospective series 102 non-variceal upper GI bleeders were studied. An indication for endoscopic injection therapy was seen in 63 patients. In accordance with bleeding intensity, 27 patients were grouped as Forrest Ia, 37 as Forrest Ib, 8 as Forrest II with a "visible vessel" and 13 as Forrest II without one. Definitive hemostasis was achieved in almost 100% of the cases. Within the Forrest Ia group mortality was lowered to 11% as compared with 20% within the emergency surgery group. More than 80% of patients had at least one severe coexistent illness. The aim of endoscopic injection is to avoid surgery in high-risk patients.

Topics: Adolescent; Adult; Aged; Child; Endoscopy; Epinephrine; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions

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

A patient with anorectal varices is reported. Anorectal varices are a rare cause of rectal bleeding and are often erroneously diagnosed as bleeding hemorrhoids. However, the subcutaneous extension of the varices should alert the clinician. Although local treatment such as ligation of the varices has been advocated, in the presence of portal hypertension a more radical operation is recommended. A portosystemic shunt, preferably between the inferior mesenteric vein and the vena cava or renal vein, is then the treatment of choice.

Topics: Aged; Combined Modality Therapy; Female; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis, Biliary; Polidocanol; Polyethylene Glycols; Rectum; Varicose Veins; Veins

Topics: Gastrointestinal Hemorrhage; Humans; Methods; Polidocanol; Polyethylene Glycols; Sclerosing Solutions

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

Topics: Aged; Colon; Colostomy; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Male; Polidocanol; Polyethylene Glycols; Postoperative Complications; Rectal Neoplasms; Sclerosing Solutions; Varicose Veins

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

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

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

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

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

Treatment was required in nine cases (1.7%) of haemorrhage after endoscopic sphincterotomy performed in 508 patients during 1981/82. Infiltrations with adrenalin (1: 10 000) and 1% polidocanol solution resulted in immediate arrest of haemorrhages in all cases. The endoscopic intervention could thus be completed successfully without further delay. The haemostatic effect was, without exception, permanent. There were no specific complications or late reactions.

Topics: Cholangitis; Cholestasis; Endoscopy; Epinephrine; Female; Gallstones; Gastrointestinal Hemorrhage; Hemostatics; Humans; Polidocanol; Polyethylene Glycols; Postoperative Complications; Sphincter of Oddi

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

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

A case of successful treatment of a bleeding duodenal varix in a patient with portal hypertension and compensated cryptogenic cirrhosis (Child A) is reported. The 42-year-old man had a history of recurrent gastrointestinal hemorrhage over 14 years. In 1966 he underwent a portocaval shunt operation. Angiography in 1968 revealed a thrombosis of the shunt as well as of the splenic vein. Splenectomy was performed because of hypersplenism. In 1980 bleeding from esophageal varices occurred and was treated by sclerotherapy. Seven weeks after sclerotherapy massive bleeding from a duodenal varix occurred. Sclerotherapy of the duodenal varix via a flexible endoscope proved successful. Since then, during a follow-up period of 15 months, the patient has had no further bleeding episodes.

Topics: Adult; Duodenoscopy; Duodenum; Gastrointestinal Hemorrhage; Humans; Male; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Varicose Veins

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