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PubMed1988

Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices.

A total of 152 consecutive children with oesophageal varices have been endoscopically reviewed since 1979. In all, 108 of these children presented with variceal bleeding which was managed by injection sclerotherapy. Variceal obliteration was achieved in 33 (92 per cent) children with extrahepatic portal hypertension and 54 (75 per cent) with intrahepatic portal hypertension. Prophylactic injection sclerotherapy was used to obliterate large varices in 11 children with no history of haemorrhage. Bleeding episodes occurred in 38 (39 per cent) children before variceal obliteration was complete. However, the mortality rate from variceal bleeding was only 1 per cent. Complications were oesophageal ulceration (29 per cent) and stricture (16 per cent) which both resolved with conservative management. During a mean follow-up period of 2.9 years after sclerotherapy, recurrent oesophageal or gastric varices developed in 12 (12 per cent) cases, with rebleeding in 9 (9 per cent), but all responded successfully to a second course of treatment. These results are superior to contemporary surgical management and injection sclerotherapy should therefore currently be the primary treatment of choice for bleeding oesophageal varices in children.

Adolescent↗
PubMed1988

Endoscopic sclerotherapy in the treatment of gastric varices.

Of 309 patients with portal hypertension, gastric varices were found in 48 (16 per cent). While the majority (88 per cent) of the patients had gastric varices in association with oesophageal varices, 6 (12 per cent) patients had 'isolated' gastric varices. Gastric varices were seen significantly (P less than 0.01) more often with grade 4 than with grade 3 varices. In 11 (28 per cent) of the 40 patients who completed sclerotherapy for oesophageal varices, gastric varices disappeared concurrently on eradication of oesophageal varices or during the following 6 months. Of the initial five patients with gastric varices who received direct intravariceal injections, four rebled; this technique was therefore replaced by combination (paravariceal + intravariceal) gastric variceal sclerotherapy. Emergency combination sclerotherapy successfully controlled bleeding from gastric varices in six of the eight treated patients. Thirty-two patients entered a programme of elective combination gastric variceal sclerotherapy. Variceal obliteration was achieved in 12 cases (38 per cent) and reduction in size was noted in another 7 patients (22 per cent) after a minimum of four courses. There were 11 (23 per cent) deaths, 8 due to uncontrolled bleeding from gastric varices and 3 due to hepatic coma. The other complications of gastric variceal sclerotherapy were minor and included retrosternal pain, fever and dysphagia. It is concluded that gastric varices often coexist with large oesophageal varices. If they persist for 6 months after eradication of oesophageal varices, a combination of paravariceal and intravariceal sclerotherapy should be attempted for their obliteration.

Emergencies↗
PubMed1988

Trial of sclerosing agents in patients with oesophageal varices.

Forty-five cirrhotic patients with oesophageal varices underwent endoscopic injection sclerotherapy in a prospective randomized trial carried out to compare two sclerosing agents (5 per cent ethanolamine oleate and 2 per cent sodium tetradecyl sulphate (STD] with respect to safety, efficacy and complications. Twenty-three patients were allocated to the ethanolamine group and twenty-two to the STD group. The rate of control of acute bleeding was 100 per cent (6/6) in the ethanolamine group and 75 per cent (3/4) in the STD group. There was a significantly lower rate of postinjection bleeding after the over-tube was removed at the initial session of sclerotherapy when ethanolamine was injected 0/23 versus 7/22, 32 per cent; P less than 0.01) and at the second session there was a significantly (P less than 0.01) higher rate of jet-like bleeding from injection sites in the STD group (6/21, 29 per cent) than in the ethanolamine group (0/22). The disappearance rate of red colour signs 1 week after the initial session of sclerotherapy in the ethanolamine group was 100 per cent and 62 per cent in the STD group. Early oesophageal ulcers developed less frequently in the ethanolamine group (0 and 9 per cent) than in the STD group (24 per cent and 43 per cent both after the initial (P less than 0.05) and the second session of sclerotherapy (P less than 0.01]. Early bleeding from an oesophageal ulcer occurred only in the STD group (5/21, 24 per cent) before the third session of sclerotherapy (P less than 0.05). The rate of early mortality did not differ between the two groups. We conclude that ethanolamine seems to be safer and more efficacious than STD for sclerosing oesophageal varices.

Clinical Trials as Topic↗
PubMed1989

Variceal haemorrhage after failed injection sclerotherapy: the role of emergency oesophageal transection.

In a planned sequential policy for the emergency control of continued bleeding from oesophageal varices, oesophageal transection was performed after failure of conservative treatment, including injection sclerotherapy. In 15 patients who underwent emergency oesophageal transection, bleeding was controlled by operation in the majority (87 per cent), but 11 of the 15 patients died in hospital. Mortality in patients with poor liver function (Child's C) was 100 per cent, the majority of deaths resulting from hepatic and renal failure. The results of this study suggest that emergency oesophageal transection to control acute variceal haemorrhage is associated with a poor prognosis in patients with poor liver function and questions its role in a sequential emergency treatment policy.

Adult↗
PubMed1989

Alcohol sclerotherapy of non-parasitic cysts of the liver.

Between 1980 and 1987, nine patients with non-parasitic cysts of the liver were treated with computed tomography-guided percutaneous puncture and evacuation of the cyst contents followed by injection of absolute alcohol as a sclerosing agent. During the same period only one patient was treated with surgery. The patients included seven women and two men with a mean age of 62 years. Three patients had a single cyst and six patients had multiple cysts. The size of the largest cysts varied between 5 and 20 cm (mean 10 cm). Patients with multiple liver cysts had repeated punctures and sclerosing procedures (up to eight times); 50-3100 ml of cyst fluid (mean 650 ml) was drained per procedure. One patient had symptoms of moderate alcohol intoxication; otherwise no complications were noted. Follow-up was performed with computed tomography or ultrasonography for 8-54 months (median 18 months). The results have been considered successful in eight out of nine patients who had cyst regression and reduced symptoms. Two patients, however, required additional surgical treatment due to residual and multiple cysts. Computed tomography-guided alcohol sclerotherapy of non-parasitic liver cysts appears to be a safe and effective initial therapy.

Adult↗
PubMed1989

Variceal hemorrhage.

Explore the source record for details and available documents.

Esophageal and Gastric Varices↗
PubMed1989

Human thrombin plus 5 per cent ethanolamine oleate injected to sclerose oesophageal varices: a prospective randomized trial.

Fifty cirrhotic Japanese patients with oesophageal varices underwent sclerotherapy in a prospective randomized trial carried out to examine the effects of human thrombin given concomitantly with the sclerosant 5 per cent ethanolamine oleate. The two groups (25 patients each) were comparable with regard to size of the oesophageal varices, and the aetiology and severity of the liver disease. Twenty-five patients, 13 and 12 in the thrombin + and - groups, respectively, had at least one episode of variceal bleeding. The remaining 25 were given prophylactic injections. There was a significantly lower rate of occurrence of bleeding from injection sites when the injection needle was removed at the initial session of sclerotherapy in the thrombin + group, where human thrombin was injected (0.2-0.3 ml, 100-150 units per injection) just before removal of the injection needle. Endoscopy at 1 week after the initial session showed a significantly (P less than 0.05) higher rate of disappearance of red colour signs on varices in the thrombin + group (96 per cent) than in the thrombin - group (72 per cent). Fibrin degradation product E-fraction (FDP-E) values increased 1 h, 1 day and 6 days after the initial session of sclerotherapy in the two groups. The rate of increase in FDP-E values 1 h after sclerotherapy was significantly larger (P less than 0.001) in the thrombin + than in the thrombin - group. There was no clinical sign of disseminated intravascular coagulation. Administration of human thrombin plus a sclerosant seems to be useful and efficacious, especially for patients with huge oesophageal varices.

Endoscopy↗
PubMed1989

Rigid endoscopy under general anaesthesia is safe for chronic injection sclerotherapy.

Injection sclerotherapy for acutely bleeding oesophageal varices has been used in Belfast since 1958. However, a chronic injection sclerotherapy programme with rigid oesophagoscopy under general anaesthesia commenced only in 1979. So far, 82 patients have entered the programme; 57 patients had already received 73 acute injections before commencing chronic sclerotherapy. Subsequently, the 82 patients received 221 chronic injections plus a further 29 acute injections for rebleeding episodes which occurred during the programme. There were 24 Child's grade A patients, 23 B and 35 C; 48 per cent had alcoholic cirrhosis. Forty-eight patients achieved variceal obliteration with a mean of four injections. During the programme 24 patients experienced 42 acute bleeds. There were only two bleeding episodes within 1 week of a chronic injection and eight within 4 weeks. In the 8-year period there have been four early deaths. One occurred 17 days after a chronic injection and three followed acute injections required for rebleeding during the programme. There were 21 late deaths, mostly due to progressive liver failure, and none from rebleeding. We conclude that chronic injection sclerotherapy using rigid oesophagoscopy under general anaesthesia is both safe and effective.

Adolescent↗
PubMed1989

Platelet aggregability after endoscopic intravariceal injection of 5 per cent ethanolamine oleate into oesophageal varices.

Platelet aggregability and the coagulative and fibrinolytic systems were examined in 45 patients who underwent endoscopic injection sclerotherapy for oesophageal varices. Five per cent ethanolamine oleate, the sclerosant used, was injected into the oesophageal varices. There were significant increases in the concentrations of fibrinopeptide A, fibrinopeptide B-beta-15-42 and fibrin degradation products-E after the sclero-therapy. At 1 h after the sclerotherapy the mean(s.e.m.) platelet aggregation was significantly suppressed to 71.9(4.2) per cent of that before the treatment (P less than 0.01). There was a gradual recovery within 1 week to the same level seen before the sclerotherapy. Thromboxane B2 and 6-keto-prostaglandin F1 alpha, both stable products of thromboxane A2 and prostacyclin respectively, showed significant temporary increases after the sclerotherapy (P less than 0.01). The peak increase in the level of thromboxane B2 was noted within 1 h after the sclerotherapy and earlier than that for 6-keto-prostaglandin F1 alpha. This increased ratio of prostacyclin and thromboxane A2 may be related to the marked limitation in platelet aggregation.

6-Ketoprostaglandin F1 alpha↗
PubMed1990

Eradication of oesophageal varices recurring after portal non-decompressive surgery by injection sclerotherapy.

The results of injection sclerotherapy for oesophageal varices which recurred after portal non-decompressive surgery were analysed retrospectively to evaluate its efficacy. We treated 60 consecutive patients with portal hypertension; 19 were treated on an emergency basis, seven electively and 34 on a prophylactic basis. All acute bleeding was controlled with one session of sclerotherapy using a transparent overtube. After eradication by sclerotherapy, no bleeding episodes occurred and there was no recurrence of the varices, except in three uncompliant patients, during a mean follow-up period of 33.1 months. Bleeding from a gastric ulcer and gastritis occurred in one patient each. Oesophageal stenosis occurred in nine (15 per cent) patients and gastric varices developed in two (3 per cent) patients. Twelve patients died, five from liver failure and six with hepatoma, but there was no bleeding from the gastrointestinal tract. The overall 4-year survival rate was 80 per cent. We recommend the use of sclerotherapy as the primary treatment for recurrent oesophageal varices.

Adult↗
PubMed1991

Injection sclerotherapy for bleeding varices: risk factors and complications.

Risk factors for complications after injection sclerotherapy were studied in 163 patients undergoing 667 treatments for bleeding oesophageal varices. The overall mortality rate was 7 per cent per injection sclerotherapy session; 16 per cent per acute session and 2.4 per cent per elective session. Acute variceal bleeding was controlled by injection sclerotherapy in 91 per cent of patients. Complications occurred after 16 per cent of injection sclerotherapy sessions. Deaths and complications were significantly associated with poor modified Child's grading (P less than 0.001), the first variceal bleed (P less than 0.001), acute injection sclerotherapy (P less than 0.001) and the use of the rigid oesophagoscope (P less than 0.001).

Esophageal and Gastric Varices↗
PubMed1996

Role of endoscopic injection therapy in the treatment of bleeding peptic ulcer.

Of patients with peptic ulceration who are actively bleeding at endoscopy, 80 per cent will continue to bleed or rebleed in hospital; 50 per cent of those who have a non-bleeding visible vessel will also rebleed. Endoscopic injection treatment stops active bleeding and prevents further haemorrhage in most of these patients. The mechanism of action may include tamponade, vasoconstriction, sclerosis, tissue dehydration and thrombogenesis; substances injected include adrenaline, sclerosants, alcohol, thrombin, or a combination of agents. Although trials often define the need for surgery as an injection treatment failure, an alternative view is that endoscopic control may facilitate safe, early, elective surgery. A successful outcome may require a combination of endoscopic and operative approaches.

Decision Making↗
PubMed2006

Ultrasound-guided foam sclerotherapy for the treatment of varicose veins.

BACKGROUND: The aim was to assess the early efficacy and complications of ultrasound-guided foam sclerotherapy (UGFS) in a cohort of patients with varicose veins. METHODS: Of 192 consecutive patients referred with varicose veins over 15 months, only 11 chose surgery; the rest underwent UGFS treatment. Polidocanol was foamed 1 : 3 with air. Under ultrasound control via butterfly or Seldinger cannulation, 1 per cent foam was injected into superficial veins and 3 per cent foam into saphenous trunks, up to a total volume of 14 ml. Outcome was defined as complete when occlusion of the saphenous trunk and/or over 85 per cent of the varicosities was achieved, and partial closure when less. RESULTS: In 163 legs, complete occlusion occurred after one intervention, a further 32 after a second, and one after a third (overall 91 per cent). Of the remainder, all other legs achieved partial occlusion after up to three interventions, apart from two legs with great saphenous vein (GSV) incompetence, which failed. All 23 legs with small saphenous veins had complete occlusion after one intervention compared with 64 of 97 legs with GSV incompetence (P < 0.010). Occlusion rates were also higher when the GSV was cannulated directly: 56 of 70 versus 8 of 27 (P < 0.001). CONCLUSIONS: UGFS achieved early complete occlusion safely in over 90 per cent of legs with varicose veins.

Adult↗
PubMed1996

Ethanol sclerosis can be a safe and useful treatment for pericardial cyst.

We report the case of a 41-year-old man with a pericardial cyst treated by percutaneous aspiration and ethanol injection. He was referred to our hospital because of electrocardiographic abnormality. On admission, chest x-ray revealed a large pericardial cyst in the right cardiophrenic angle. The cyst was examined by echocardiography, computed tomography, and cytological analysis of aspiration fluid from the cyst. Ethanol sclerosis was applied for treatment of the cyst, which had continued to increase in size. There was no recurrence of the cyst 6 months after the treatment. Percutaneous ethanol sclerosis can be the first choice of treatment for pericardial cyst.

Adult↗