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C Söderlund

Publications and source records attributed to C Söderlund.

28 records · Page 2Linked to original sources
PubMed1985

Endoscopic sclerotherapy v. conservative management of bleeding oesophageal varices. A 5-year prospective controlled trial of emergency and long-term treatment.

A comparative trial was made of conservative therapy (balloon tamponade and/or vasopression infusion) alone (control group) or with addition of acute and serial endoscopic injection sclerotherapy (ST group). The 107 unselected patients, mainly with alcoholic cirrhosis, were randomly allocated to these groups, which were comparable as regards Child's grading and clinical and laboratory findings. For emergency ST a fibreoptic endoscope and Williams sheath were used. In initial control of index bleed and hospital mortality the two groups did not differ significantly. The median follow-up was 15 and 28 months (minimum 1 year). Supplementary ST (mainly out-patient) gave variceal eradication in 34 of 41 patients, with most failures in persistent alcoholics. A calculated risk factor for rebleeds was 3.6 times higher in the controls than in the ST group. Mortality rate showed no intergroup difference. The cause of death mainly was variceal bleeding in the controls, but not in the ST group. Major complications of treatment occurred in c. 15% of all patients.

Angioplasty, Balloon↗
PubMed1985

Oesophageal motility after sclerotherapy for bleeding varices.

Endoscopic injection sclerotherapy (ST) has gained wide acceptance as emergency and definitive treatment of bleeding oesophageal varices. The long-term effects of serial ST on oesophageal motility were studied in 19 patients with cirrhosis and prior variceal bleeding. A control group of 14 patients with compensated cirrhosis has been conservatively treated for major variceal haemorrhage a median of 5 months previously. In the ST group, eradication of the varices by serial ST had been completed a median of 7 months prior to manometry. The manometric results did not differ between the controls and 11 ST patients without dysphagia (SA). In eight ST patients with dysphagia (SB), the percentage of deglutitive peristaltic contractions (DPC) in the lower oesophagus was less than in the controls (31.4 vs. 98.6%) and in the SA patients (84%). Nonpropulsive contractions instead dominated in the lower oesophagus, but were frequent also in the upper part, resembling the motility pattern seen in patients with sclerodermal involvement of the oesophagus. When seven SB patients were reinvestigated after a median of 11.5 months (without further ST), the DPC value had increased to 74.2% and the dysphagia had decreased. The lower oesophageal sphincter pressure did not differ between the controls and the subgroups of ST patients.

Adult↗
PubMed1985

Endoscopic sclerotherapy of oesophageal varices. A clinical study.

Haemorrhage from oesophageal varices is a serious and feared complication of liver cirrhosis. One hundred and five patients treated for their first major variceal haemorrhage (VH) 1976-1979 were reviewed. Conventional therapy in a material with 60% Child class C patients with alcoholic cirrhosis resulted in a 50% first bleeding and a 36% readmission mortality with a one year survival of 30%. The conclusion was that the management schedule could be improved and that endoscopic sclerotherapy (ST) should be further evaluated. Conservative therapy and the addition of emergency and serial ST was compared in a prospective controlled trial in 107 unselected patients with major VH. Two-thirds belonged to Child's class C and 90% had alcoholic cirrhosis. Initial control of VH was obtained in 90% of all patients and the admission mortality was about 30%. The causes of mortality were mainly VH in 50 conservatively treated patients and hepatic failure and to VH unrelated causes in the ST-group (57 patients). Supplementary ST, a median of 6 sessions, succeeded in eradication of the varices in 34 of the 41 ST-patients discharged, failure was due to early death or continued alcoholism. Varices recurred in 5 patients during a 2-year follow-up. The number of rebleeds per observation month was overall decreased 3.6 times in the ST-group, but the survival was not prolonged. The effect of initial and serial ST on the mediastinal portalsystemic collaterals was investigated prospectively in 26 patients by repeated selective percutaneous transhepatic portography (PTP) and endoscopy. PTP was performed immediately prior to, and just after the first ST, showing reduced or inhibited contrast filling of oesophageal varices delineated on the pre-ST films in three-fourth of the patients. In 21 patients, follow-up PTP was carried out a median of 8 months later, when the varices were eradicated by serial ST. In 17 patients PTP supported the endoscopic estimation of variceal eradication, one patient was found to have residual varices. These patients were followed for a year, two patients developed recurrent varices. This study showed that submucosal oesophageal varicose veins can be efficiently eradicated by serial ST with a low recurrence rate. Oesophageal necrosis with delayed perforation intervened in 4% of our ST-patients with fatal outcome. Complications were noted in 30% of the patients treated with ST, and were major in 18%, mainly ulcerations with bleeding and transmural necrosis. Strictures encountered in 15% of the patients were easily treated. Oesophageal manometry was performed in 31 patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1983

Oesophageal perforation after sclerotherapy for variceal haemorrhage.

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.

Adult↗
PubMed1982

Variceal haemorrhage. A study of unselected patients with massive bleeding from oesophageal varices.

A series of 105 unselected patients treated at Södersjukhuset, Stockholm, Sweden 1976-1979 for massive haemorrhage from oesophageal varices is presented. Ninety per cent of the patients had alcoholic cirrhosis and 60% belonged to the poorest liver risk group on admission. The diagnosis of variceal haemorrhage was assessed by early endoscopy and/or autopsy. Treatment was mainly conservative, balloon-tamponade or vasopressin infusion. Twenty-five patients received additional therapy; Portacaval shunt surgery, percutaneous transhepatic variceal obliteration or endoscopic injection sclerotherapy. Despite this treatment along with early panendoscopy and modern intensive care facilities the mortality remained high. The hospital mortality was 50% during the first bleeding episode and 35% during recurrent variceal haemorrhage. Average hospital mortality was 44% and mean one year survival was 30%. In this study the long and short time survival after variceal bleeding relates strongly to the severity of the liver disease on admission. This must be fully taken into consideration before adopting sophisticated and costly operative techniques when simple nonoperative measures would give the same or better results.

Adult↗
PubMedDate not supplied

Sclerotherapy of esophageal varices: an endoscopic and portographic study.

A prospective series of 26 patients with portal hypertension and recent bleeding from esophageal varices was investigated with percutaneous transhepatic selective portography (PTP). PTP was performed immediately prior to and, in 23 patients, just after the initial endoscopic injection sclerotherapy (ST) session to study the acute effects of ST on the mediastinal portal-systemic collaterals. Late follow-up PTP was performed after a median of 8 months in 21 of 26 patients considered endoscopically to be free from esophageal varices after a median of 6 ST sessions. Five patients rebled from esophageal or gastric varices during the follow-up period of 15 months, but there were no fatalities due to variceal hemorrhage. In all patients, the initial PTP showed portal-systemic mediastinal collaterals. Immediately after ST, it was not possible to opacify esophageal varices at all (10 patients) or only partially (7 patients). Five patients died prior to late follow-up PTP. Endoscopic judgment of complete eradication of esophageal varices after repeated ST was in agreement with the late PTP results in 18 of 21 patients. In one patient, PTP showed residual esophageal varices subsequently confirmed by endoscopy. The results were uncertain in two patients for technical reasons. This study supports the opinion that submucosal esophageal varicose veins, as visualized by PTP, can be efficiently eradicated by serial ST, leaving the other mediastinal collaterals unaffected.

Endoscopy↗
PubMedDate not supplied

Endoscopic therapy in primary sclerosing cholangitis: outcome of treatment and risk of cancer.

BACKGROUND/AIMS: Primary sclerosing cholangitis is a cholestatic liver disease characterized by multifocal strictures in the intra- and extrahepatic biliary tree. Dominant strictures may arise in the extrahepatic bile ducts, and in these circumstances, endoscopic therapy has been introduced to relieve cholestasis and perhaps also delay the development of liver cirrhosis. The experience of endoscopic treatment at this point in time is limited and the long-term benefit is not clear. Neoplastic transformation in primary sclerosing cholangitis is unpredictable, which is illustrated in the present study along with an evaluation of the efficacy of endoscopic treatment. METHODOLOGY: Endoscopic retrograde cholangiopancreatography was performed in 25 patients with primary sclerosing cholangitis. In 15 there were dominant strictures in the hilum of the liver and/or the distal bile duct and these patients were treated by dilation and/or endoprostheses. Four patients in the treatment group had just cholestatic biochemical test results and 11 were symptomatic. RESULTS: Endoscopic therapy was technically successful in all 15 patients. In 43 sessions, 5 patients were treated by dilation, 2 with endoprostheses, and 8 by both methods. Improvement was achieved radiologically in 12 patients, clinically in 8, and according to liver function tests in 7. Therapy was complicated by cholangitis in 5 patients. Complications were mild and there was no mortality related to the procedure. However, 6 patients in the treatment group died, 5 of cholangiocarcinoma and 1 of colon cancer. CONCLUSIONS: Endoscopic therapy in primary sclerosing cholangitis is indicated in selected patients. The cancer incidence is high, not least in patients with deteriorating disease. It is important to find techniques for identifying patients at risk in order to perform liver transplantation before malignant transformation.

Adult↗