Evaluation of endoscopic injection sclerotherapy with and without simultaneous ligation for the treatment of esophageal varices

Abstract

For more effective and simple endoscopic injection sclerotherapy (EIS) for esophageal varices, we developed an EIS procedure with ligation (EISL) that is non-invasive, in which EIS and endoscopic variceal ligation (EVL) are performed simultaneously. In this study, we compared EISL and EIS in a randomized sample of patients (n = 14 for each procedure). For EISL, EVL was performed, including the injection site, after the injection of 5% ethanolamine oleate with iopamidol (EOI) into a varix. The mean number of treatment sessions required for eradication of esophageal varices was 2.3+/-0.5 for EISL and 3.9+/-0.8 for EIS (P < 0.001); the mean number of treatment sites was 6.2+/-2.2 for EISL and 14.0+/-5.0 for EIS (P < 0.001); the mean total amount of EOI used was 13.8+/-5.2ml for EISL and 26.3+/-9.8ml for EIS (P < 0.001). There were no significant differences in rates of recurrence of varices or in bleeding between the two groups. For EISL, fewer treatment sessions and less sclerosant were sufficient, probably because the sclerosants were more effective due to the blockage of variceal blood flow by the ligation. This method should provide a novel modification of EIS.

Ultrasonographic and histologic evaluation of medial and middle patellar ligaments in exercised horses following injection with ethanolamine oleate and 2% iodine in almond oil

“…6,14,15 Because EO can rapidly diffuse through the vessel wall, an extravascular inflammatory response also results. In humans, EO is most commonly used to treat varicosities of the saphenous vein, esophagus, and hemorrhoids.…”

Variceal transection of esophageal varix using the ESD method: new treatment technique for esophageal varix (with video)

“…Congenital duodenal membrane is an anomaly characterized by luminal GI obstruction and consists of a diaphragm with multiple central or peripheral openings. 1,2 The clinical presentation depends on the size of the fenestrations of the diaphragm. In cases of severe stenosis, vomiting and abdominal distention are the presenting symptons.…”

Management of bleeding in the cirrhotic patient

“…There have been attempts at combining sclerotherapy with banding but the results of these studies are controversial. [43][44][45][46][47][48][49][50][51][52][53][54] Transjugular intrahepatic portasystemic shunts refers to the implantation of an expandable metal stent bridging the hepatic and portal veins via a jugular vein puncture. Transjugular intrahepatic portasystemic shunts achieve decompression of the portal system to systemic veins without an open surgical operation.…”

“…There is some evidence that recurrence of varices is more rapid after band ligation, when compared with sclerotherapy. There have been attempts at combining sclerotherapy with banding but the results of these studies are controversial 43–54 …”