polidocanol and Hypertension--Portal

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

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

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

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

Endoscopic 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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