polidocanol and Liver-Cirrhosis--Alcoholic

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

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

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