polidocanol and Liver-Cirrhosis

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

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

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

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

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 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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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