Sclerotherapy of Esophageal Varices: Acute Arrest of Gastrointestinal Hemorrhage or Long-term Therapy?

Soehendra, Nib; Heer, Koen de; Kempeneers, I.; Runge, Marschall S.

doi:10.1055/s-2007-1021488

Cited by 54 publications

(17 citation statements)

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“…Endoscopic injection sclerotherapy (EIS) is widely used; however, many endoscopists have been performing solely topical injections under an endoscopic monitor only [1, 2]. This method tends to be inferior to endoscopic variceal ligation [3]because few endoscopists can inject sclerosant intravariceally into the blood supply accurately.…”

Section: Discussionmentioning

confidence: 99%

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Short-Term Portal Hemodynamic Effects of Endoscopic Embolization for Esophageal Varices

Chikamori¹,

Kuniyoshi²,

Shibuya

et al. 2000

Dig Surg

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Background/Aim: Endoscopic embolization (EE) is a specialized treatment that obliterates esophageal varices along with their associated blood supply. The purpose of this study was to investigate the short-term effects of EE for esophageal varices on portal hemodynamics and liver function. Methods: Thirty patients with esophageal varices were included in this study. The portal blood flow was measured by an ultrasonic duplex Doppler system before and after EE. EE was performed by freehand intravariceal injection of 5% ethanolamine oleate with iopamidol with the aid of a balloon attached to the tip of an endoscope under fluoroscopy. Results: For the blood supply system, endoscopic varicography at the time of EE was able to show the vessels of the cardiac branch of the left gastric vein in 93% of the cases, the cardiac venous plexus in 90%, the trunk of the left gastric vein in 27%, the lesser curvature branch of the left gastric vein in 10%, the fundic branch of the short gastric vein in 13%, and the posterior gastric vein in 13%. For the blood drainage system, endoscopic varicography was able to show the paraesophageal vein in 39% of the cases, the inferior phrenic vein in 17%, and the mediastinal vein in 13%. No clotting was detected after EE in the intra- and extraportal veins in any of the cases. The flow velocities in the main portal vein before and after EE were 14.2 ± 3.2 and 15.5 ± 3.5 cm/s, respectively, showing no significant change. The cross-sectional area of the portal vein before and after EE was 0.96 ± 0.21 and 1.04 ± 0.23 cm², and the flow volume of the portal vein was 817 ± 288 and 930 ± 189 ml/min, both also showing no significant change. The blood laboratory parameters showed no significant change after EE. Conclusions: We conclude that neither portal blood flow nor liver function were damaged by EE, although both the varices and their associated blood supply were obliterated.

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Section: Discussionmentioning

confidence: 99%

“…The first method treats only the esophageal varices [1, 2, 3], and the second treats the varices along with their blood supply [4, 5, 6]. We have used the latter method, known as endoscopic embolization (EE).…”

Section: Introductionmentioning

confidence: 99%

Short-Term Portal Hemodynamic Effects of Endoscopic Embolization for Esophageal Varices

Chikamori¹,

Kuniyoshi²,

Shibuya

et al. 2000

Dig Surg

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“…Group I1 comprised 13 patients in whom the source of bleeding before initiation of treatment was gastric or esophageal varices. polidocanol in five patients [intra-and paravariceally, according to the method of Soehendra et al (12)]. Endoscopic examinations were systematically performed 1 week and 1 month after obturation of all varices.…”

Section: Selection Of Patientsmentioning

confidence: 99%

Successful endoscopic obturation of gastric varices with butyl cyanoacrylate

et al. 1989

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In 27 patients who had bled from esophagogastric varices, large-sized and/or actively bleeding gastric varices were endoscopically obturated with the tissue adhesive butyl cyanoacrylate. Active bleeding was stopped in six patients. Rebleeding occurred in 10 patients; in four patients, rebleeding was due to ruptured gastric varices, occurred early and was successfully treated by reinjection of gastric varices; in one patient, rebleeding was attributed to ulceration on an injected gastric varix. Eight patients died: two of rebleeding (from esophageal varices or undetermined source), four of sepsis and/or liver failure and two at home of undetermined cause. No specific complication due to injection of gastric varices was observed. The results obtained in this series of patients with gastric varices obturated by injection of butyl cyanoacrylate are much more satisfactory than those obtained in previously published series of patients with gastric varices treated by injection of sclerosants.

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“…They can be divided into those occurring at the site of injection (mostly ulcerations and esophageal fibrosis [20]) and into those originating from injection and systemic dissemination of the sclerosant (mostly fever, bacteremia [72,76], or pulmonary side effects [32,52,71]). In prospective therapeutic clinical trials [38,47,58,73,77,78,[87][88][89]94] fatal complications ranged between 0% and 13% (median 2.5%), mostly caused by perforation of the esophagus, aspiration pneumonia, and bleeding esophageal ulcers. Although the risk of fatal complications is supposed to be lower in patients undergoing elective sclerotherapy, it has to be kept in mind that 1% to 2% of the patients may die by endoscopic prophylaxis.…”

Section: Prophylactic Sclerotherapymentioning

confidence: 99%

Prophylaxis of first variceal hemorrhage in patients with liver cirrhosis

et al. 1986

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Summary. Prophylaxis of bleeding from esophageal varices is a very tempting concept at first glance, especially under the assumption of a high mortality associated with first variceal hemorrhage. Up to now four different measures have been tried for prophylaxis: portacaval shunt operation, devascularization procedures, sclerotherapy, and drugs. With the exception of portacaval shunts, ongoing controlled trials show a weak trend toward reduction of variceal bleeding and prolongation of survival in selected patients with compensated cirrhosis and large varices. However, prophylaxis of first variceal bleeding must still be regarded as experimental and should be restricted to controlled clinical studies.

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Sclerotherapy of Esophageal Varices: Acute Arrest of Gastrointestinal Hemorrhage or Long-term Therapy?

Cited by 54 publications

References 0 publications

Short-Term Portal Hemodynamic Effects of Endoscopic Embolization for Esophageal Varices

Short-Term Portal Hemodynamic Effects of Endoscopic Embolization for Esophageal Varices

Successful endoscopic obturation of gastric varices with butyl cyanoacrylate

Prophylaxis of first variceal hemorrhage in patients with liver cirrhosis

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