Endoscopic Sclerosis and Esophageal Balloon Tamponade in Acute Hemorrhage From Esophagogastric Varices: A Prospective Controlled Randomized Trial

Paquet, Maryse; Feußner, H.

doi:10.1002/hep.1840050409

Cited by 277 publications

(79 citation statements)

References 15 publications

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“…One patient in each group received transjugular previous studies usually observed a short period, such as 8 intrahepatic portosystemic stent shunt after endoscopic or 12 hours. 6,10 In Sung's study, initial control of bleeding treatment failure. Patients requiring vasoconstrictors to con-with emergency EIS was 90%, with a rebleeding rate of 16% trol bleeding were significantly higher in the sclerotherapy within 48 hours.…”

Section: Resultsmentioning

confidence: 99%

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Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices

et al. 1997

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acute variceal bleeding proved to be superior to vasoconstricActive bleeding varices are a great challenge to endostors or balloon tamponade in the control of hemorrhages. [5][6][7] copists. In this study, we compared the short-term effiNevertheless, substantial complications may be associated cacy and safety of banding ligation with injection sclerowith EIS. 8 Furthermore, while EIS has been used extentherapy in the arresting of active bleeding from sively, it also has not had a significant impact on survival.4 esophageal varices. Seventy-one cirrhotic patients with Endoscopic variceal ligation (EVL) has been adopted in recent active variceal bleeding were randomized to receive years to substitute for EIS in managing bleeding esophageal banding ligation (37 patients) or sclerotherapy (34 pavarices.9 tients) immediately after endoscopic examinations. PriMost controlled studies comparing EVL with EIS favored mary success rate (bleeding stopped for 72 hours) was EVL in terms of sessions required to achieve variceal oblitera-97% in the ligation group and 76% in the sclerotherapy tion, rebleeding rate, and complication rate. [10][11][12][13] On the other group (P Å .009). The efficacy of ligation was similar to hand, EIS and EVL were found to be of similar effectiveness sclerotherapy in the control of oozing varices (100% vs.in terms of arresting active bleeding. 14 However, all of those 89%, P Å .23), whereas ligation was superior to sclerostudies comprised only a small number of patients with active therapy in the control of spurting varices (94% vs. 62%, variceal bleeding. Thus, a larger study comparing EVL with P Å .012). The requirement of vasoconstrictors after EIS for the control of active variceal bleeding is mandatory. emergency endoscopic treatment was lower in the ligaThis study was undertaken to investigate the efficacy and tion group than in the sclerotherapy group (11% vs. 41%, safety of EIS and EVL in the control of active bleeding from P Å .007). Treatment failure within 1 month was 8% in esophageal varices. the ligation group vs. 30% in the sclerotherapy group (P Å .02). Blood transfusion requirements were signifi-PATIENTS AND METHODS cantly lower in the ligation group than in the sclerotherapy group (3.2 { 1.2 vs. 4.5 { 1.8 units, P õ .01). RebleedBetween October 1991 and June 1995, seventy-one consecutive ing rate within 1 month was 17% in the ligation group cirrhotic patients with active variceal bleeding admitted to Veterans and 33% in the sclerotherapy group (P Å .19). Significant General Hospital-Kaohsiung (Taiwan, Republic of China) were enrolled in the study. All of the patients were proven to be actively complications were encountered in 5% of the ligation bleeding from esophageal varices by emergency endoscopy within 12 group and 29% of the sclerotherapy group (P Å .007).hours of admission. Among them, emergency endoscopy was perMortality rates within 1 month were 19% in the ligation formed in forty-two patients within 6 hours of entry to the emergency group and 35% in the sclerotherapy gr...

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Section: Resultsmentioning

confidence: 99%

“…[5][6][7] copists. In this study, we compared the short-term effiNevertheless, substantial complications may be associated cacy and safety of banding ligation with injection sclerowith EIS.…”

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confidence: 99%

Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices

et al. 1997

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“…Randomized trials comparing tamponade to sclerotherapy for EVB show trends or significant benefit for sclerotherapy in initial hemostasis, and all indicate better sustained or definitive hemostasis with sclerotherapy. (6)(7)(8) Thus, tamponade for acute EVB is not better than medical therapy, is less effective than endoscopic therapy, and not uncommonly causes serious and sometimes fatal complications. My view has been that the use of tamponade should be exceedingly rare: e.g., patients with persistent massive known EVB awaiting endoscopy or awaiting transjugular intrahepatic portosystemic shunt after unsuccessful endoscopic intervention.…”

Section: Balloon Tamponadementioning

confidence: 99%

Deflating balloon tamponade: Should we expand the use of stents for severe refractory esophageal variceal bleeding?

Laine

2016

Hepatology

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A cute esophageal variceal bleeding (EVB) remains among the most serious emergencies managed by gastroenterologists and hepatologists. Most patients do well during the acute episode with current endoscopic and pharmacologic therapy. In this issue of HEPATOLOGY, Escorsell and colleagues report a randomized trial comparing a very old and a very new intervention for the challenging minority of patients with refractory acute EVB.(1) Acute EVBCurrent guidelines recommend endoscopic ligation and vasoactive medication for treatment of acute EVB, with consideration of transjugular intrahepatic portosystemic shunt in high-risk patients.(2) Randomized trials indicate that 2%-13% of patients with acute EVB treated as recommended have persistent or recurrent bleeding over 5 days or during hospitalization. (3,4) Consensus guidelines recommend transjugular intrahepatic portosystemic shunt for patients who have persistent bleeding despite initial endoscopic and medical therapy, while a second endoscopic treatment may be tried if bleeding recurs after initial hemostasis. (2) Balloon tamponade is currently recommended only for refractory EVB as a temporary bridge to definitive therapy.(2) However, randomized trials have not focused solely on patients with persistent active bleeding despite endoscopic and medical intervention, the high-risk group in whom balloon tamponade may be considered. Balloon TamponadeBalloon tamponade is among the oldest therapies used for variceal bleeding. Case series suggest initial bleeding control in 90% of patients.(5) Major complications, including esophageal rupture, airway obstruction, and aspiration pneumonia, occur in 12% of patients and may be lethal.(5) Deaths attributed to use of balloon tamponade occurred in 6% of patients in these series. (5) Randomized trials comparing tamponade to medical therapy with vasopressin, somatostatin, or terlipressin reveal no significant difference in initial control of bleeding or mortality. Randomized trials comparing tamponade to sclerotherapy for EVB show trends or significant benefit for sclerotherapy in initial hemostasis, and all indicate better sustained or definitive hemostasis with sclerotherapy. (6)(7)(8) Thus, tamponade for acute EVB is not better than medical therapy, is less effective than endoscopic therapy, and not uncommonly causes serious and sometimes fatal complications. My view has been that the use of tamponade should be exceedingly rare: e.g., patients with persistent massive known EVB awaiting endoscopy or awaiting transjugular intrahepatic portosystemic shunt after unsuccessful endoscopic intervention. Self-Expanding Metal StentsThe removable covered self-expanding metal stent used by Escorsell et al. was designed specifically to treat EVB Abbreviation: EVB, esophageal variceal bleeding.

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“…Subsequently, the varix becomes organized and eventually disappears [20]. Several drugs have been used as sclerosants including Aethoxysklerol, sodium tetradecyl sulfate, sodium morrhuate, absolute alcohol and ETH [5,6,[21][22][23][24]. In a recent in vivo rat study ETH was found to be superior to Aethoxysklerol because it controlled thrombosis but damaged a smaller area [].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Ethanolamine Oleate as a Pleural Sclerosing Agent in Rabbits

Teixeira

Vargas²,

Carmo³

et al. 1998

Respiration

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The ideal pleural sclerosing agent should be easily administered, without significant side effects, inexpensive, and widely available. None of the agents presently used meets all of these criteria. Ethanolamine oleate (ETH) is a sclerosing agent used in the sclerotherapy treatment of varicose veins of the legs and esophagus. The objective of the present study was to assess the efficacy of ETH as a pleural sclerosant in rabbits. An additional objective was to assess if better results were obtained when dextrose 50% (D50) as opposed to saline was used as the diluent. Each group of 10 rabbits received a total volume of 2 ml intrapleurally. The eight treatments were as follows: (1) 2 ml saline; (2) 2 ml D50; (3) 25 mg ETH plus 1.5 ml saline; (4) 25 mg ETH plus 1.5 ml D50; (5) 50 mg ETH plus 1.0 ml saline; (6) 50 mg ETH plus 1 ml D50; (7) 75 mg ETH plus 0.5 ml D50, and (8) 100 mg ETH. The rabbits were sacrificed 28 days after the injection. The intrapleural instillation of ETH resulted in evident pleurodesis, which was dose-dependent; 100 mg ETH induced significantly (p < 0.05) more adhesions than did any other treatment. The selection of the diluent had no effect on the pleurodesis. The microscopic examination of the right visceral pleura showed that the mean degree of fibrosis after 100 mg ETH was significantly (p < 0.05) greater than that after the other solutions. The mean degree of pleural inflammation, lung inflammation and lung fibrosis was minimal in all the groups. From this study we conclude that undiluted ETH produces pleurodesis in our experimental model. At the doses used, the pleurodesis was less than that produced after talc, tetracycline derivatives or silver nitrate in the same model.

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Endoscopic Sclerosis and Esophageal Balloon Tamponade in Acute Hemorrhage From Esophagogastric Varices: A Prospective Controlled Randomized Trial

Cited by 277 publications

References 15 publications

Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices

Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices

Deflating balloon tamponade: Should we expand the use of stents for severe refractory esophageal variceal bleeding?

Effectiveness of Ethanolamine Oleate as a Pleural Sclerosing Agent in Rabbits

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