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PubMed2002

Endoscopic clipping versus band ligation in the management of bleeding esophageal varices.

BACKGROUND: The effectiveness of endoscopic clipping in the hemostasis of bleeding esophageal varices and the eventual variceal eradication was compared with that of band ligation. METHODS: Forty patients were enrolled in the study in a prospective manner, 19 of whom received endoscopic clipping (group I) and the remaining (n = 21 patients) received endoscopic band ligation (group II). All patients in this study presented with bleeding from esophageal varices. The patient characteristics (age, sex, Child-Pugh score, variceal grade) were comparable in the two groups. After initial hemostasis, the patients were assigned one of the two forms of endoscopic therapy which was continued in the follow-up sessions until varices were eradicated. Early and late results were compared. RESULTS: Initial hemostasis was achieved in all patients in group I but two patients in group II required clip ligation for initial hemostasis because of the failure in band ligation. Those two were treated with band ligation in the follow-up sessions. A total of 224 clips in 53 treatment sessions and 296 bands in 82 treatment sessions were placed in group I and group II, respectively. The rates of complete variceal eradication were 89% and 76% in group I and group II, respectively (p > 0.05). The median number of required treatment sessions for complete eradication of the varices was significantly lower in group I than group II (3 versus 4, p = 0.013). Three patients from group I (15%) and seven patients from group II (33%) were readmitted for variceal bleeding during the follow-up period (p > 0.05). CONCLUSIONS: With the advantages of high initial hemostasis rate, decreased risk of rebleeding, and fewer treatment sessions needed for variceal eradication, endoscopic clipping is as effective as band ligation, or perhaps more effective in the treatment of bleeding esophageal varices.

Blood Transfusion↗
PubMed2006

Endoscopic band ligation of small gastric stromal tumors and follow-up by endoscopic ultrasonography.

BACKGROUND: Gastrointestinal stromal tumor (GIST) is a relatively common gastric submucosal tumor with potential for malignant transformation. The efficacy of a new method for resection of these tumors, endoscopic band ligation, was evaluated. METHODS: The study included 29 patients with small gastric stromal tumors arising in the gastric muscularis propria as determined by endoscopy, endoscopic ultrasonography (EUS), and deep endoscopic biopsies. A standard endoscope with a transparent cap attached to the tip was used. The cap was placed over the lesion, maximum sustained suction was applied, and an elastic band was released around the base. Beginning two weeks after banding, the lesions were observed endoscopically once per week until healing was complete. Thereafter, all patients underwent EUS every two to three months on schedule. RESULTS: The 28 GISTs sloughed completely. The mean time required for complete healing after band ligation was 4.8 weeks. One lesion did not slough because they were not completely ligated. The lesion was ligated for the second time and sloughed completely. Bleeding occurred in one patient three days after ligation because the lesion sloughed early. The bleeding was managed successfully with metallic clips. No perforation and other complications occurred. Followup ranged from 36 to 51 months, during which time only one recurrence was observed four months postoperatively. CONCLUSIONS: Endoscopic band ligation with systematic followup by EUS is an effective and safe treatment for small GISTs.

Adult↗
PubMed2005

Use of the six-shooter ligation device in the management of bleeding esophageal varices: a developing-country experience.

Endoscopic variceal ligation has emerged as a superior alternative to endoscopic injection sclerotherapy, however, the "single-shot" mechanism of the generally used Stiegman-Goff ligator made the procedure tedious and time-consuming and required overtube placement, associated with discomfort and potentially life-threatening complications. In this study we describe our experience with the Saeed Six-Shooter (multiple-ligation device). Fifty consecutive patients with variceal bleeding were prospectively studied. After initial endoscopic ligation, subsequent sessions were every 2 weeks. Study outcomes were: the ability to control active bleeding, the frequencies of rebleeding, the number of treatment sessions and time required for irradication, the percentage eradication of varices, complications, and mortality. Active bleeding was controlled in all eight (100%) patients. Four (8%) patients rebled, three from esophageal varices, and one from portal hypertensive gastropathy. Esophageal varices were eradicated in 47 (94%) patients (3.1 +/- 1.3 sessions). Time needed till eradication was 6.2 +/- 1.9 weeks. Chest pain was reported in two (4%), low, grade pyrexia in two (4%), and pneumonia in one (2%) patient. There were three deaths, none due to exsanguination. The Six-Shooter is a safe and efficient device for the endoscopic ligation of esophageal varices which has overcome the limitations of the single-shot ligator: (1) Visualization is better (the endoscopic "tunnel vision" and internal light reflection from the stainless-steel banding cylinder of the single-shot device are avoided); and (2) the use of an overtube is no longer necessary and serious complications can be avoided.

Egypt↗
PubMed1977

Primary arterial ligation in resection of cancer of the colon. Rational and technic.

The dynamics of arterial, venous, and lymphatic flow in the mesentery were studied in dogs, using an electromagnetic flowmeter for the blood and cannulation and gravimetric measurement for the lymph. Ligation of veins caused an increased venous outflow in adjacent veins and a marked increase in lymph flow. When marginal vessels were ligated, eliminating the major collateral flow, venous flow decreased, but elevated lymph flow persisted. Simultaneous ligation of arteries and veins resulted in increases of both arterial and venous flow in adjacent vessels. Lymph flow decreased unless excessive arterial collateral flow persisted. When collateral marginal vessel flow was occluded, adjacent venous and arterial blood flow decreased to control levels. With arterial ligation, collateral arterial blood flow increased slightly, but venous and lymph flow decreased sharply. When collateral marginal vessels were eliminated, adjacent arterial blood flow decreased to control levels and venous flow virtually stopped. As a result of these studies, the technic of early primary arterial ligation followed by marginal vessel ligation appears to be the most satisfactory procedure for decreasing venous and lymphatic outflow and hopefully avoiding dissemination of cancer cells during the operation. This technic is now being used as a modification of the "no touch" technic for cancer of the colon.

Animals↗
PubMed1987

Uterine artery ligation to control postpartum hemorrhage.

Bilateral uterine artery ligation was performed for 32 patients in order to control intractable postpartum hemorrhage in 25 of them (currative ligation) and as prophylaxis against postpartum hemorrhage in seven (elective ligation). Mass ligation was used for 29 patients and isolation ligation for three. Among the 25 patients for whom curative ligation was performed, successful hemostasis was achieved in 20 patients (80%) and the technique failed in five (20%). This failure was due to a clotting defect in three and placenta previa accreta in two patients. Twenty-four patients (96%) survived and one died as a result of a clotting defect. Among five patients followed up, normal menstruation occurred with pregnancy in three of them.

Arteries↗
PubMed1983

Long-term function of duct-ligated and free-duct whole pancreas transplants.

This report compares endocrine and exocrine responses of "free-duct" and "duct-ligated" whole pancreas isografts in Lewis diabetic rats during a 1-year period of observation. Fasting blood sugar, serum amylase, serum insulin, pancreozymin-secretin test, and L-arginine tolerance test assays were performed prior to and at periodic intervals after transplantation. Histological examinations of transplanted and native pancreas were performed monthly on animals in each group. Whole pancreas transplantations led to immediate and sustained normalization of FBS and insulin levels. In the "duct-ligated" group there was a gradual but insignificant decrease of serum insulin levels after 9 months. Depressed serum amylase levels in diabetic rats were reversed in both groups. Isolated islet iso- and allografts also reversed depressed amylase levels. The results of pancreozymin-secretin tests in islet isografted animals supported the postulated trophic effect of endocrine pancreas on exocrine pancreas. Although both whole-pancreas transplant groups showed a normal response to GTT for 12 months after transplantation, the "duct-ligated" group showed a significantly lower response to L-arginine tolerance test than the "free duct" model as early as 4 months after transplantation, suggesting a defect in B-cell function in long-term "duct-ligated" graft. Serial histological examinations of transplanted pancreases revealed more rapid atrophy and more intense fibrosis of acinar tissue in the "duct-ligated" group than in the "free duct" group. These results suggest that a "free duct" pancreatic isograft maintains a more stable endocrine function in a long-term study than does the "duct-ligated" pancreas, and that exocrine dysfunction in diabetic rats may be related to the endocrine disorder which can be reversed by both islet cell and whole-organ pancreatic transplantation.

Amylases↗
PubMed1984

Effects of blood flow reduction and lymphatic ligation on coronary transport in dogs.

We studied the effects of reduced-flow coronary ischemia and coronary lymphatic ligation on transcapillary movement of albumin. We infused 125I-albumin intravenously into four groups of five anesthetized, open-chest dogs in which external carotid-to-coronary arterial cannulas had been placed. One group was subjected to both lymphatic ligation and ischemia; a second group to lymphatic ligation only; a third group ischemia only; and the fourth was a control group. After 1 hr, 85Sr-microspheres were injected into the cannula. After 2 hr, the animals were sacrificed. Extravascular albumin activities in heart sections that were perfused from the cannula were normalized to extravascular albumin in normal-flow regions. This variable was greater in the lymph-ligated and ischemic groups than in the control, and greater in the combined lymph-ligated and ischemic group than any other group. Relative increase in coronary vascular resistance over the protocol interval correlated significantly with normalized albumin content in the cannulated sections. Although both ischemia and lymph ligation lead to increased extravascular albumin accumulation, their mechanisms are different. Increased extravascular albumin after ischemia may be due to increased capillary permeability.

Albumins↗
PubMed1993

Randomised trial of variceal banding ligation versus injection sclerotherapy for bleeding oesophageal varices.

Injection sclerotherapy of bleeding oesophageal varices is undoubtedly beneficial but it is associated with a substantial complication rate, and variceal rebleeding is common during the treatment period before variceal obliteration is achieved. We aimed to find out whether endoscopic variceal banding ligation is safer and more effective. The two methods were compared in a randomised controlled trial of 103 patients (54 assigned to banding ligation, and 49 to injection sclerotherapy) of whom 21 (39%) and 23 (47%), respectively, had active bleeding at index endoscopy. Both treatments were highly effective in controlling active haemorrhage (91% and 92% respectively). Variceal obliteration was not achieved for 22 patients in each group, but among those whose varices were eradicated, banding ligation achieved obliteration more quickly than did sclerotherapy (mean 39 [SD 4] vs 72 [7] days, p = 0.004) and in fewer endoscopy sessions (3.4 [2.2] vs 4.9 [3.5], p = 0.006). Rebleeding was less common in the banding ligation group than in the sclerotherapy group (16 [30%] vs 26 [53%], p < 0.05). There was no difference in outcome between the groups, but 14 sclerotherapy patients were withdrawn from the trial (7 for orthotopic liver transplantation) compared with only 5 (1 for liver transplantation) in the banding ligation group (p < 0.05). Complication rates were similar in the two groups. Variceal banding ligation is a safe and effective technique, which obliterates varices more quickly and with a lower rebleeding rate than injection sclerotherapy.

Adult↗
PubMed1992

Effects of bilateral jugular vein ligation on intracranial pressure and cerebrospinal fluid outflow resistance in cats.

In order to study the effect of jugular venous outflow obstruction on intracranial pressure and cerebrospinal fluid (CSF) reabsorption capability, changes in epidural pressure (EDP) and CSF outflow resistance (Ro) were examined following bilateral jugular vein ligation in cats. EDP increased significantly (P less than 0.01) immediately after ligation from the control value of 4.9 +/- 0.5 mmHg (mean +/- SEM) to 15.9 +/- 0.9 mmHg. Thereafter, EDP gradually decreased back toward the control value. The pressure level had decreased to 6.7 +/- 0.5 mmHg by 20 minutes after ligation. The mean Ro was significantly (P less than 0.01) higher in the ligation group (200.4 +/- 9.7 mmHg/ml/min) that in the non-ligation group (120.0 +/- 9.9 mmHg/ml/min). These results suggest that bilateral jugular vein ligation impairs CSF reabsorption.

Absorption↗
PubMed2004

Potentiation of anandamide effects in mesenteric beds isolated from bile duct-ligated rats: role of nitric oxide.

Changes in vascular responsiveness are proposed as the basis for some of the cardiovascular complications in cholestasis. Cholestasis is also associated with accumulation of endogenous opioid peptides and evidence of nitric oxide (NO) overproduction. On the other hand, it is well known that anandamide, an endogenous cannabinoid ligand, causes hypotension and a decrease in systemic vascular resistance. In the present study, the possible role of the cannabinoid system in cholestasis-induced mesenteric vascular bed responsiveness was investigated. Mesenteric arteries of bile duct-ligated and sham-operated rats receiving daily administrations of saline were used for evaluating phenylephrine or anandamide dose-response, acute effects of N(G)-nitro-L-arginine methyl ester (L-NAME, 100 microM), a non-selective inhibitor of NO synthase (NOS), or naltrexone, an opioid receptors antagonist (1 microM). The other groups of bile duct-ligated and sham-operated rats received daily intraperitoneal administration of L-NAME (20 mg/kg/day), aminoguanidine, a selective inducible NOS (iNOS) inhibitor (150 mg/kg/day) or naltrexone (10 mg/kg/day). After 7 days, the superior mesenteric artery was cannulated and the mesenteric vascular bed was perfused according to the McGregor method. Anandamide-induced relaxation was significantly potentiated in mesenteric vascular beds of bile duct-ligated rats. Chronic treatment of bile duct-ligated animals with L-NAME and aminoguanidine blocked this hyperresponsiveness while the hyperresponsiveness was potentiated at large doses of anandamide on chronic treatment of these animals with naltrexone. Although acute L-NAME treatment of mesenteric beds completely blocked the anandamide-induced vasorelaxation in sham-operated rats, this vasorelaxation still was present in bile duct-ligated animals. Anandamide-induced vasorelaxation remained unaffected after acute naltrexone treatment of mesenteric beds in both bile duct-ligated and sham-operated rats. Our results indicate that (1) there is enhanced anandamide-induced vasorelaxation in cholestatic rats, probably due to a defect in cannabinoid or vanilloid receptors and (2) NO overproduction may be involved in cholestasis-induced vascular hyperresponsiveness.

Animals↗
PubMed2004

[Intractable postpartum haemorrhages: where is the place of vascular ligations, emergency peripartum hysterectomy or arterial embolization?].

OBJECTIVE: Update of knowledge on the various methods of management of intractable postpartum haemorrhage. METHOD: PubMed, MEDLINE were the electronic sources, in English and French languages, used for data retrieval. Uterine atony and abnormal placental insertions (placenta praevia or accreta) are the major causes of primary postpartum haemorrhages. To preserve fertility, we dispose of angiographic selective embolization or surgical vascular ligations. Embolization is a non-invasive method practicable by simple catheterization under local anesthesia. Vascular ligations of the uterine vessels or internal iliac arteries require mostly laparotomy. New and easier surgical methods, such as uterine compression or hemostatic suturing techniques have been described for which we lack experience. RESULTS: For uterine atony, the success rate of arterial embolization and uterine artery ligations is close to 100%. Ligation of internal iliac arteries is a little less effective and technically more difficult to carry out. It remains interesting in obstetrical traumatic hurts, which do not concern the uterus. If bleeding from the lower segment occurs during caesarean section, low uterine artery ligatures are necessary. These methods are all the more effective than they are prematurely implemented before the rise of major coagulopathy. In this case, uterine devascularization has also to be applied to ovarian vessels. With placenta accreta, accreta portion of the placenta can be left in place and arterial embolization or vascular ligations can be done. Nevertheless the main cause of failure with conservative treatments is placenta accreta. CONCLUSION: The simplest and the least morbid methods must be retained. After vaginal birth, arterial embolization can be done, if there is no maternal haemodynamic disorder nor interventional vascular radiology unit nearby. During caesarean section, progressive uterine artery ligation can be done adapted to the bleeding cause. In case of failure of a conservative treatment, it would be dangerous to multiply techniques. Emergency peripartum then should remain the choice procedure.

Arteries↗
PubMed2006

A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding.

BACKGROUND/AIMS: The currently recommended treatment for acute variceal bleeding is the association of vasoactive drugs and endoscopic therapy. However, which emergency endoscopic treatment combines better with drugs has not been clarified. This study compares the efficacy and safety of variceal ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin. METHODS: Patients admitted with acute gastrointestinal bleeding and with suspected cirrhosis received somatostatin infusion (for 5 days). Endoscopy was performed within 6h and those with esophageal variceal bleeding were randomized to receive either sclerotherapy (N=89) or ligation (N=90). RESULTS: Therapeutic failure occurred in 21 patients treated with sclerotherapy (24%) and in nine treated with ligation (10%) (RR=2.4, 95% CI=1.1-4.9). Failure to control bleeding occurred in 15% vs 4%, respectively (P=0.02). Treatment group, shock and HVPG >16 mmHg were independent predictors of failure. Side-effects occurred in 28% of patients receiving sclerotherapy vs 14% with ligation (RR=1.9, 95% CI=1.1-3.5), being serious in 13% vs 4% (P=0.04). Six-week survival probability without therapeutic failure was better with ligation (P=0.01). CONCLUSIONS: The use of variceal ligation instead of sclerotherapy as emergency endoscopic therapy added to somatostatin for the treatment of acute variceal bleeding significantly improves the efficacy and safety.

Acute Disease↗
PubMed2006

Comparison of suture ligation and clip application for the treatment of patent ductus arteriosus in preterm neonates.

OBJECTIVE: We reviewed the experience of 2 centers performing surgical ligation of patent ductus arteriosus in preterm neonates to identify whether the choice of surgical technique--suture ligation or clip application--affected outcome. METHODS: Between 2000 and 2005, 67 newborn infants had open surgical closure of patent ductus arteriosus: 33 by suture ligation and 34 by clip application. The groups were similar in age and sex. RESULTS: The average length of the procedure was 55.8 +/- 13.7 minutes for suture ligation and 30.8 +/- 8.7 minutes for clip application (P < .05). Six neonates had intraoperative bleeding in the suture ligation group. Four patients had significant postoperative complications in the suture ligation group, compared with 2 in the clip application group. CONCLUSIONS: This study demonstrates that clip application results in a significant reduction in the operative time and, possibly, in less morbidity.

Cardiac Surgical Procedures↗
PubMed2001

Influence of phenobarbital on changes in Na(+) handling, hemodynamics and liver function due to partial portal vein ligation in rats.

This study examined the influence of phenobarbital, an inducer of hepatic enzymes, on Na(+) handling, hemodynamics and liver function (measured by the rate constant of elimination of aminopyrine in the aminopyrine breath test) after partial portal vein ligation. Rats were randomized to drink either phenobarbital + water or water only for 10 days and then underwent either sham operation or partial portal vein ligation. The aminopyrine rate constant of elimination and Na(+) balance were measured daily before and after surgery; after surgery, hemodynamic measurements were obtained daily in a subset of rats. Phenobarbital raised the baseline aminopyrine rate constant of elimination. Partial portal vein ligation, but not sham operation, caused equivalent reductions in the aminopyrine rate constant of elimination in phenobarbital- and water-treated groups, such that the aminopyrine rate constant of elimination remained higher in the former. Na(+) balance increased significantly in partial portal vein ligation + water, but not sham + water rats on day 1 and then decreased on days 2 and 3. In contrast, neither sham + phenobarbital nor partial portal vein ligation + phenobarbital rats had a significant increase in Na(+) balance. Partial portal vein ligation resulted in vasodilation on day 3 after surgery in the water-treated rats, an effect that was prevented by treatment with phenobarbital. These results support previous suggestions that a reduction in liver function triggers renal Na(+) retention in this model. Vasodilation is not necessary for the latter effect, but also appears to be dependent on a reduction in liver function.

Animals↗
PubMed1979

Testicular testosterone concentration following testicular vein ligation.

UNLABELLED: A rat model to study the local effects of testicular vein ligation is described. One hour after unilateral testicular vein ligation, the testicular concentration of testosterone was significantly greater (P less than 0.01) on the side that was ligated than in the contralateral testis (177.1 +/- 19.7 [SEM] ng/gm of tissue as compared with 108.8 +/- 11.8 ng/gm of tissue, respectively). This effect was not seen 1 week after the testicular vein ligation. The testosterone concentration in the ligated testis was also higher than that in sham-operated animals. These differences in testicular testosterone concentration were not associated with changes in peripheral serum testosterone levels. CONCLUSION: ligation of the testicular vein causes an acute rise in the testicular concentration of testosterone and may thus mediate changes in testicular function.

Animals↗
PubMed2005

Safety of band ligator use in the small bowel and the colon.

BACKGROUND: Endoscopic band ligation for bleeding small-bowel vascular lesions has been reported as safe and efficacious based on small case series. There have been several other published case reports of band ligators used for bleeding lesions, usually Dieulafoy's lesions, in the stomach, the proximal small bowel, and the colon. In addition, this method has been used for postpolypectomy bleeding stalks. There has never been a critical look at the anatomic consequences of banding in the thinner sections of bowel. METHOD: The purpose of this study is to define the anatomic and histologic consequences of applying band ligator devices to the small and the large bowel. Fresh surgical specimens, both large and small bowel, that were excised because of neoplastic lesions were transported to our endoscopy unit where one end of the intact bowel was sutured shut. A standard upper endoscope was passed via the open end, and the bowel was closed tightly with rubber band ties. The bowel then was insufflated, and band ligators were applied to unaffected mucosa by using a standard technique. Photodocumentation from inside and outside the bowel was obtained. Some of the band polyps were cut above the band, and some were cut below the band in the fresh state. Some were fixed in formalin and examined microscopically. Histologic sectioning occurred at the level of the bands. RESULTS: The results were striking in that there were large holes (1 cm) in the fresh ileum specimen. There was gross serosal entrapment manifested by visible puckers on the outer surfaces of the specimens, especially in the small bowel and the right colon. The left colon, anatomically thicker, was less affected. The histologic evaluation revealed inclusion by the band ligator of the muscularis propria and serosa on the small bowel, the muscularis propria in the right colon, and the submucosa in the left colon. CONCLUSIONS: Based on these findings, we conclude that band ligator devices are not safe in the small bowel and the right colon but probably are safe in the thicker left colon.

Colon↗
PubMed1995

Endoscopic variceal ligation versus conservative treatment for patients with hepatocellular carcinoma and bleeding esophageal varices.

BACKGROUND: Endoscopic variceal ligation (EVL) is currently a favored treatment for control of bleeding from esophageal varices. However, little is known about the treatment of bleeding varices in hepatocellular carcinoma. METHODS: EVL was performed in 16 patients with bleeding esophageal varices due to concomitant hepatocellular carcinoma. Treatment results were compared with those of another 23 patients who were conservatively treated. RESULTS: Comparing the two groups, ligation significantly reduced the risk of fatal bleeding (44% vs 70%; P < 0.05). Significantly fewer patients in the ligation group died at the time of the index hemorrhage (11% vs 52%; P < 0.05). Rebleeding occurred in 44% of the ligation group and 73% in the control group (P > 0.05). The mean days of survival were 40 +/- 20 (range, 7 to 103) in the ligation group and 20 +/- 30 (range, 1 to 136) in the control group (P = 0.08). In the absence of portal vein thrombosis, ligation significantly reduced the rebleeding rate (17% vs 50%, P < 0.05) and the mortality rate (0% vs 100%, P < 0.05). CONCLUSION: EVL is a good choice for palliation in patients with esophageal variceal bleeding and hepatocellular carcinoma. Aggressive use of EVL may be tried in those patients without portal venous thrombosis.

Adult↗
PubMed1979

Electrocardiographic QRS changes induced by acute coronary ligation in the isolated rabbit heart.

The electrical fields associated with augmented R- and decreased S-wave amplitudes during acute, severe myocardial ischemia were studied in fifteen isolated rabbit heart preparations. Hearts were suspended in a spherical tank and perfused with oxygenated electrolyte solution. Electrocardiographic signals were recorded from electrodes on the tank's surface and processed by computerized methods. Fifteen minutes after suture ligation of the left anterior descending coronary artery, records from electrodes overlying the lesion demonstrated increased R-wave amplitude and ST-segment elevation. Fitting a single moving dipole to pre- and post-ligation potentials demonstrated that the ligation increased the dipolarity of the field and shifted the terminal QRS dipole to a position topographically related to the location of the ischemic lesion. The effects of injury were further assessed by study of fields computed by subtracting control from post-ligation data. This generated a dipolar field at the instant of maximal dipole moment whose strength directly correlated (r=0.74) with the area of non-perfused epicardium, as determined by post-ligation methylene blue infusion. These results suggest that the electrical fields generated during mid to late dipolarization by coronary ligation are qualitatively similar to those generated during repolarization, and may therefore be of similar clinical and/or experimental value.

Action Potentials↗