sodium-morrhuate and Gastrointestinal-Hemorrhage

We report two cases of squamous cell carcinoma of the esophagus following endoscopic injection sclerotherapy for esophageal varices. The interval between sclerotherapy and the development of carcinoma was 24 months in case 1 and 21 months in case 2. The sclerosant was 5% sodium morrhuate in case 1 (total dose, 10 ml) and 5% ethanolamine oleate in case 2 (45.5 ml). Although no recurrent variceal bleeding occurred after sclerotherapy, we could not perform any curative surgical treatment for esophageal cancer because of the advanced stage of the cancer and the severity of the accompanying liver dysfunction. It is difficult to determine the relationship between sclerotherapy and carcinoma; however, long-term surveillance is essential to avoid overlooking a neoplasm in the esophagus after endoscopic injection sclerotherapy.

Topics: Carcinoma, Squamous Cell; Esophageal and Gastric Varices; Esophageal Neoplasms; Esophagoscopy; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Oleic Acids; Sclerosing Solutions; Sclerotherapy; Sodium Morrhuate; Time Factors

Sclerotherapy is currently used to treat acute variceal bleeds and also in the long-term management after a variceal bleed. The technical variants and results of sclerotherapy in both settings are reviewed and compared with alternative surgical treatment options. Sclerotherapy has become an accepted therapy for acute variceal bleeding. In Cape Town it is used in combination with the Sengstaken tube. A preliminary analysis of an ongoing trial comparing a rigid scope technique with a fibreoptic scope technique provides support for the use of the rigid scope in acute variceal bleeding. The place of repeated sclerotherapy in long-term management has become controversial. Varices can be eradicated and repeated variceal bleeds markedly reduced, but its role in improving survival requires further clarification.

Topics: Acute Disease; Combined Modality Therapy; Esophageal and Gastric Varices; Esophagoscopes; Gastrointestinal Hemorrhage; Gastroscopes; Humans; Oleic Acids; Portasystemic Shunt, Surgical; Sclerosing Solutions; Sodium Morrhuate

The current standard treatment of bleeding esophageal varices is band ligation. Although endoscopic sclerotherapy has largely been supplanted by band ligation, there are still clinical situations in which injection methods are useful. Endoscopic ultrasound (EUS) may allow for a more complete evaluation of esophageal varices and perforating veins and may allow for more effective delivery of sclerosant. Our aim was to evaluate the use of color Doppler EUS-guided sclerotherapy for the obliteration of esophageal varices.. Five patients with esophageal varices (Child's A = 1, B = 2, C = 2) underwent dynamic EUS-guided sclerotherapy with color flow Doppler. EUS sclerotherapy was performed using Varijet (2.5 mm catheter) injector needles and sodium morrhuate directed at the perforating vessels until flow was completely impeded (2 to 4 mL per injection site). Data collected included (1) sessions to obliteration, (2) episodes of recurrent bleeding, (3) complications, and (4) mortality.. Patients undergoing EUS-sclerotherapy required 2.2 sessions to achieve obliteration of varices. No patient had a recurrence of bleeding and no deaths occurred. One patient developed an esophageal stricture that responded to balloon dilation.. Dynamic EUS-guided sclerotherapy with color flow Doppler may be safely and effectively used for the treatment of esophageal varices. It allows for effective delivery of sclerosant with favorable outcomes. Prospective, multicenter, randomized trials are warranted.

Topics: Endosonography; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Pilot Projects; Sclerosing Solutions; Sclerotherapy; Sodium Morrhuate; Ultrasonography, Doppler, Color

Thirteen Child's class C patients with variceal hemorrhage requiring 6 or more units of blood were randomly assigned to groups receiving either flexible endoscopic sclerotherapy using 5% sodium morrhuate or esophageal transection/reanastomosis employing the EEA Auto Suture stapling instrument. One patient with a previous hiatus hernia repair was assigned to the transection group and had a mesocaval shunt. The randomization groups compared favorably with each other and with a retrospective shunt group (20 patients). Although transection patients required significantly less operative time and fewer blood transfusions, the outcome of the transection group was significantly worse than that of the shunt group. The trend in survival likewise favored the shunt group rather than the sclerotherapy group. Although the reported operative mortality rates of transection and sclerotherapy are less than that of portal decompression, the results of this study--the first controlled trial of these procedures--would warrant distinct caution in using either of these new techniques in high-risk patients. Portal decompression may still be the procedure of choice in class C patients with substantial variceal hemorrhage.

Topics: Adult; Clinical Trials as Topic; Endoscopy; Esophageal and Gastric Varices; Esophagus; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Portacaval Shunt, Surgical; Prospective Studies; Random Allocation; Retrospective Studies; Sclerosing Solutions; Sodium Morrhuate; Surgical Staplers

The safety and efficacy of poly-N-acetyl glucosamine (p-GlcNAc) gels were compared with standard agents in three different dog studies to assess abdominal venous collaterals, bleeding esophageal varices, and bleeding gastric varices.. Adult dogs with prehepatic portal hypertension and large abdominal venous collaterals, esophageal varices, or gastric varices were studied.. Significantly higher sclerosis rates were seen with F2 or F4 p-GlcNAc gels and standard sclerosants. F2 and F4 gels had high rates of permanent hemostasis, low rates of secondary ulceration, and significant reductions in esophageal and gastric variceal size. These results were either equivalent to or significantly better than the most commonly used gastric varix hemostatic agent (glue) or other sclerosing agents.. F2 and F4 poly-N-acetyl glucosamine gels are promising therapeutic agents for venous and variceal hemostasis.

Topics: Acetylglucosamine; Alcohols; Animals; Chemistry, Pharmaceutical; Disease Models, Animal; Dogs; Double-Blind Method; Drug Evaluation, Preclinical; Enbucrilate; Esophageal and Gastric Varices; Esophagoscopy; Gastrointestinal Hemorrhage; Gastroscopy; Gels; Hemostatic Techniques; Hemostatics; Hypertension, Portal; Oleic Acids; Random Allocation; Sclerosing Solutions; Sclerotherapy; Sodium Morrhuate; Wound Healing

Seventy-three patients with bleeding esophageal varices were treated by transesophageal injection of sclerosing agent through fiberoptic gastroscope (EIS). Hemostasis was noted in 63 cases (86.3%). The success rate was 100% among those classified as Child A & B and 79.59% in Child C patients. Hemostasis was achieved after repeated EIS in 90.2% of the patients. Bleeding stopped in 82.14% of the patients who failed to respond to balloon tamponade and in 95.65% of the patients with recurrent bleeding after open surgery. The recurrence rate of bleeding esophageal varices after EIS was 13.7% and the mortality rate was 15.07%. EIS was generally performed in the first week of hemorrhage, thereafter, it was repeated at a 4-14 days interval. EIS was a simple and safe procedure with a high percentage of immediate hemostasis and a comparatively low mortality. It could be used to tide some poor risk patients over the crisis for possibly further surgery.

Topics: Adult; Aged; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Retrospective Studies; Sclerotherapy; Sodium Morrhuate

Twenty-seven manometric and 22 18-hour pH monitoring studies were done in 17 consecutive patients undergoing esophageal endosclerosis. Prior to endosclerosis, esophageal manometry was normal in eight of nine patients. Peristaltic dysfunction was observed in all 13 postendosclerosis patients and consisted of (1) decreased mean peristaltic amplitude pressures. Pressures were 61.4 and 74.7 mmHg at 0 to 2 cm and 3 to 4 cm above the lower esophageal sphincter (LES), respectively, prior to treatment. After endosclerosis, values fell to 30.2 and 43.3 mmHg; (2) a drop in mean resting LES pressure from 22.3 mmHg before endosclerosis to 17.1 mmHg afterward and (3) an increase in the rate of peristaltic propagation failure from 12% to 26% after endosclerosis. Esophageal pH monitoring demonstrated gastroesophageal reflux (GER) in three of seven patients before endosclerosis and in five of 11 patients afterward. Because of the major incidence of GER before endosclerosis, the procedure could not be causally incriminated. However, GER was roughly correlated with the severity of the manometric dysfunction. There was no correlation of GER or manometric abnormality with the number of endosclerosis treatment nor the interval between endosclerosis and pH and manometric studies. The remote sequelae of the abnormalities are conjectural.

Topics: Child; Esophageal and Gastric Varices; Esophagogastric Junction; Esophagus; Fatty Acids; Gastrointestinal Hemorrhage; Humans; Hydrogen-Ion Concentration; Manometry; Monitoring, Physiologic; Peristalsis; Pressure; Sodium Morrhuate

Ten years after right hepatic lobectomy for primary hepatocellular cancer, a 45-yr-old black woman presented with bleeding esophageal varices. After five endoscopic injection sclerotherapy procedures using sodium morrhuate, she developed fever and elevated white blood count. Reendoscopy, chest x-ray, and upper gastrointestinal contrast x-rays showed no local complication. Urine analysis was normal, but CT scans, renal sonograms, and white blood cell radionuclide scan demonstrated bilateral perinephric abscesses. Percutaneous abscess drainage grew Streptococcus pneumoniae, normally found in the nasopharyngeal flora, which was probably a result of hematogenous spread. The perinephric abscesses were successfully treated with percutaneous drainage and antibiotics. Renal infection should be considered as a possible locus of distant blood-borne infection in patients who develop fever after endoscopic injection sclerotherapy.

Topics: Abscess; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Middle Aged; Perinephritis; Pneumococcal Infections; Sclerosing Solutions; Sodium Morrhuate

Adult respiratory distress syndrome has been reported after endoscopic variceal sclerotherapy with sodium morrhuate. It has been proposed that sclerosant entering the pulmonary circulation during intravariceal injections may cause pulmonary hypertension and capillary injury. The purpose of this study was to determine whether variceal sclerotherapy with sodium morrhuate causes capillary injury or pulmonary edema in humans. We studied the effect of sclerotherapy on gas exchange and pulmonary and systemic hemodynamics in 8 patients who required endoscopic variceal sclerotherapy for treatment of variceal hemorrhage. The pulmonary vascular resistance index increased from 246 +/- 67 dyn X s X cm-5/m2 (mean +/- SEM) at baseline to a high of 303 +/- 85 dyn X s X cm-5/m2 60 min after sclerotherapy (normal range 250-500 dyn X s X cm-5/m2). Pulmonary artery pressure remained stable while cardiac index decreased by 12% over the same period. There were also small increases in systemic vascular resistance index and systemic arterial pressure after sclerotherapy. Although there was no change in arterial oxygen tension, the alveolar-arterial oxygen difference improved after sclerotherapy. These results indicate that variceal sclerotherapy with sodium morrhuate is associated with clinically insignificant changes in pulmonary and systemic hemodynamics. We did not detect evidence of acute lung injury after sclerotherapy.

Topics: Adult; Endoscopy; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Hemodynamics; Humans; Male; Middle Aged; Pulmonary Circulation; Pulmonary Gas Exchange; Sclerosing Solutions; Sodium Morrhuate

Topics: Adult; Aged; Animals; Dogs; Esophageal and Gastric Varices; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Sclerosing Solutions; Sodium Morrhuate

Topics: Adult; Bacterial Infections; Esophageal and Gastric Varices; Esophageal Perforation; Esophagoscopy; Gastrointestinal Hemorrhage; Humans; Male; Sclerosing Solutions; Serratia marcescens; Sodium Morrhuate

Topics: Esophageal and Gastric Varices; Eye; Eye Protective Devices; Fatty Acids; Gastrointestinal Hemorrhage; Humans; Protective Devices; Sclerosing Solutions; Sodium Morrhuate

Utilizing an equal mixture of 5% sodium morrhuate and 60% renografin, we studied four patients during a total of nine sessions of injection sclerotherapy of esophageal varices to determine radiographically the fate of injected sclerosant. Despite attempted intravariceal injections, 44% resulted in local and presumably paravariceal accumulation of contrast material within the esophageal wall. During 42% of injections, contrast material was rapidly cleared in a cephalad direction and proximal balloon compression of the esophagus did not prevent cephalad flow of sclerosant. In 14% the injected material was rapidly cleared in a caudal direction toward the gastric veins. This technique may be useful in future evaluations of the efficacy of various methods of injection sclerotherapy of esophageal varices.

Topics: Contrast Media; Diatrizoate; Diatrizoate Meglumine; Drug Combinations; Esophageal and Gastric Varices; Esophagoscopy; Esophagus; Fatty Acids; Gastrointestinal Hemorrhage; Humans; Phlebography; Sodium Morrhuate; Stomach

Deep ulceration of the esophagus is the most common significant complication of endoscopic injection sclerosis of varices. Four patients with persistent bleeding from sclerotherapy-induced ulcers were treated with sucralfate. Adherence of sucralfate to the ulcerated areas was demonstrated endoscopically, and bleeding stopped in three patients. Sucralfate may be useful in the treatment of esophageal ulcers caused by sclerotherapy.

Topics: Aluminum; Anti-Ulcer Agents; Esophageal Diseases; Esophagoscopy; Fatty Acids; Gastrointestinal Hemorrhage; Humans; Sodium Morrhuate; Sucralfate; Ulcer

Sclerotherapy for esophageal varices has recently gained wide acceptance in major medical centers for the control of bleeding esophageal varices. We have described two elderly patients with preexisting cardiac disease (right bundle branch block) in whom persistent bradyarrhythmia followed sclerotherapy using 5% sodium morrhuate. Both patients required insertion of a permanent pacemaker. This is the first report associating sclerotherapy with significant bradyarrhythmias.

Topics: Aged; Bradycardia; Esophageal and Gastric Varices; Fatty Acids; Gastrointestinal Hemorrhage; Humans; Male; Pacemaker, Artificial; Recurrence; Sclerosing Solutions; Sodium Morrhuate

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

Topics: Bronchoscopy; Esophageal and Gastric Varices; Fatty Acids; Gastrointestinal Hemorrhage; Humans; Sodium Morrhuate

Topics: Adult; Aged; Esophageal and Gastric Varices; Esophagoscopy; Fatty Acids; Gastrointestinal Hemorrhage; Humans; Middle Aged; Recurrence; Sodium Morrhuate

Two of 30 patients with esophageal varices had respiratory distress develop within 8-24 h of esophageal sclerotherapy. Evidence of aspiration and sepsis were absent in these two patients with the clinical picture of adult respiratory distress syndrome. To investigate the possible etiologic role of sodium morrhuate in this syndrome, a sheep model was established and pulmonary hemodynamics, lung lymph flow, and albumin concentration were measured before and after the intravenous injection of 2.5-15.0 cm3 of sodium morrhuate. In all 8 animals studied, mean pulmonary artery pressures increased from 11.6 +/- 2.8 to 32.8 +/- 4.9 mmHg (p less than 0.01) 30 s after injection. These pressures returned to baseline values over 120 min. Lymph flow increased from 0.91 +/- 0.89 to 2.8 +/- 1.5 ml/30 min at 90 min postinjection (p less than 0.05) and returned to baseline values in animals monitored for 6-8 h. The lymph/plasma albumin ratio decreased from 0.856 +/- 0.08 to 0.74 +/- 0.01 (p less than 0.05) 120 min postinjection. Pulmonary edema was not evident histologically or gravimetrically (wet/dry weight ratio was 3.65 +/- 0.3 and not different from normal). It was concluded that sodium morrhuate injection in sheep causes marked but transient pulmonary hypertension associated with an increased lymph flow of relatively protein-poor lymph. Sodium morrhuate esophageal sclerotherapy may affect pulmonary hemodynamics and contribute to respiratory difficulties in patients.

Topics: Animals; Esophageal and Gastric Varices; Fatty Acids; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Pulmonary; Lymph; Male; Middle Aged; Pulmonary Circulation; Pulmonary Wedge Pressure; Respiratory Distress Syndrome; Sclerosing Solutions; Serum Albumin; Sheep; Sodium Morrhuate

Three patients with portal hypertension and variceal hemorrhage were treated with flexible fiberoptic esophageal vein sclerosis by injection of sodium morrhuate. Each of these patients bled after sclerotherapy, and deep esophageal ulcers were found at the previous injection sites. Postsclerotherapy pathologic features are presented in 2 patients. It is suggested that the sclerotherapy caused esophageal ulceration and bleeding. Careful evaluation of the sclerosing technique and its histopathologic consequences is needed.

Topics: Adult; Esophageal and Gastric Varices; Esophageal Diseases; Esophagoscopes; Fatty Acids; Fiber Optic Technology; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Sodium Morrhuate; Ulcer

During the past 3 2/3 yr, 6 children with portal vein thrombosis were treated for esophageal hemorrhage by direct injection of esophageal varices with sodium morrhuate (endosclerosis). Four children were actively hemorrhaging at the time of initial endosclerosis; 2 patients were treated electively. Endosclerosis was performed by (1) employment of an especially slotted rigid esophagoscope, (2) direct intravariceal injection, (3) injection of varices at the gastroesophageal junction only. In patients actively hemorrhaging, endosclerosis was repeated every 3 to 4 days until the bleeding ceased. Once bleeding was controlled the procedure was done at 6-wk intervals until esophageal varices were obliterated. In the four patients actively hemorrhaging, bleeding was controlled by 2 to 3 separate injection sessions. Four patients have completed treatment and varices are absent radiographically and endoscopically. No patient has rebled during or after treatment in follow-up from 1/6 to 3 2/3 yr. Esophageal endosclerosis is advocated as a legitimate alternative to portosystemic shunt operations and nonoperative management of esophageal variceal hemorrhage in children with portal vein thrombosis.

Topics: Adolescent; Child; Child, Preschool; Esophageal and Gastric Varices; Esophagoscopy; Fatty Acids; Female; Gastrointestinal Hemorrhage; Humans; Infant; Male; Portal Vein; Sodium Morrhuate; Thrombosis

Topics: Child; Esophageal and Gastric Varices; Esophagoscopy; Fatty Acids; Gastrointestinal Hemorrhage; Humans; Sodium Morrhuate

Topics: Drug Evaluation; Esophageal and Gastric Varices; Ethanolamines; Gastrointestinal Hemorrhage; Humans; Sclerosing Solutions; Sodium Morrhuate

Topics: Administration, Topical; Animals; Disease Models, Animal; Dogs; Esophageal and Gastric Varices; Fatty Acids; Gastrointestinal Hemorrhage; Sodium Morrhuate