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At least 127 records · Page 7Linked to original sources
PubMed1984

Colonic variceal hemorrhage after endoscopic injection sclerosis of esophageal varices: a report of three cases.

Three of 119 patients (2.5%) bled from rectosigmoidal varices after endoscopic injection sclerosis of esophageal varices. All three patients had cirrhosis with portal hypertension. A mean of four injection procedures were performed before colonic variceal hemorrhage which followed a mean duration of 8 wk. Mean transfusion requirement was 4 U per patient. Colonoscopy and mesenteric angiography were useful in confirming the presence of rectosigmoidal varices and all patients survived with conservative therapeutic measures. No rebleeding from colonic varices was observed over a maximum 24-month follow-up period.

Adolescent↗
PubMed1982

Variceal haemorrhage. A study of unselected patients with massive bleeding from oesophageal varices.

A series of 105 unselected patients treated at Södersjukhuset, Stockholm, Sweden 1976-1979 for massive haemorrhage from oesophageal varices is presented. Ninety per cent of the patients had alcoholic cirrhosis and 60% belonged to the poorest liver risk group on admission. The diagnosis of variceal haemorrhage was assessed by early endoscopy and/or autopsy. Treatment was mainly conservative, balloon-tamponade or vasopressin infusion. Twenty-five patients received additional therapy; Portacaval shunt surgery, percutaneous transhepatic variceal obliteration or endoscopic injection sclerotherapy. Despite this treatment along with early panendoscopy and modern intensive care facilities the mortality remained high. The hospital mortality was 50% during the first bleeding episode and 35% during recurrent variceal haemorrhage. Average hospital mortality was 44% and mean one year survival was 30%. In this study the long and short time survival after variceal bleeding relates strongly to the severity of the liver disease on admission. This must be fully taken into consideration before adopting sophisticated and costly operative techniques when simple nonoperative measures would give the same or better results.

Adult↗
PubMed1995

Comparison of endoscopic variceal injection sclerotherapy and ligation for the treatment of esophageal variceal hemorrhage: a prospective randomized trial.

To determine the efficacy of endoscopic variceal sclerotherapy (EVS) and ligation (EVL) in the management of esophageal variceal bleeding, 134 cirrhotic patients were randomized to receive either treatment. The clinical and endoscopic characteristics were similar in both groups. Active bleeding was controlled with ligation (20 of 20) as efficiently as with sclerotherapy (14 of 16). Elective sclerotherapy consumed less time than ligation (7.9 +/- 1.8 minutes vs. 11.5 +/- 2.7 minutes, P < .001), but there was no difference between emergent sclerotherapy (14.5 +/- 5.8 minutes) and ligation (14.9 +/- 4.1 minutes). Ligation reduced one grade of variceal size more quickly than sclerotherapy (1.1 +/- 0.4 vs. 2.0 +/- 1.7 session, P < .001). The rebleeding rate was lower with ligation (13 of 67 vs. 28 of 67, P < .01). Esophageal ulcer was the most common source of rebleeding. Recurrence of varices appears more probable with ligation (P = .079). The complication rate was higher with sclerotherapy (15 of 67 vs. 3 of 67, P < .01), with esophageal stricture being the most common cause. Survival rate was the same in both groups even after stratifying patients into good and poor hepatic reserve groups. Hepatic failure was the major cause of death, followed by exsanguination. In summary, EVL was superior to EVS regarding rebleeding and complications but not in other aspects such as time consumption in elective treatment and recurrence of varices. Substantial results for long-term follow-up are required before conclusion of the treatment of choice.

Esophageal and Gastric Varices↗
PubMed1997

Efficacy of endoscopic variceal ligation for bleeding esophageal varices in patients with tumor thrombus of the portal vein trunk (Vp3) associated with hepatocellular carcinoma.

We studied the efficacy of endoscopic variceal ligation (EVL) in 16 patients with tumor thrombus of the portal vein trunk (Vp3) associated with hepatocellular carcinoma. The average (+/-SD) number of O rings used was 9.0 +/- 5.0 for the esophageal varices (n = 7) and 16.4 +/- 4.5 for the esophagogastric varices (n = 9). The variceal size was quickly reduced in 11 of the 13 cases whose therapeutic outcome was able to be assessed by endoscopy. The red color sign improved in 10 of the 13 cases, but the therapeutic end point (F0, RC-) was achieved in only two patients, who were also treated by endoscopic injection sclerotherapy. Emergency EVL achieved only short-term survival (17.14 +/- 6.64 days) and transient hemostasis. Elective EVL was associated with a survival duration of 90.0 +/- 64.25 days. The difference in the survival rate between emergency and elective cases was significant (P < .05). With regard to the timing of its application, EVL, being a less-invasive treatment, should be performed electively before variceal rebleeding for those patients with Vp3 hepatocellular carcinoma whose liver function is preserved.

Aged↗
PubMed2002

Effects of esophageal varices obliteration by endoscopic variceal sclerotherapy on asialoscintigraphy and liver function test.

Background: hepatic functional reserve is determined by the function and number of hepatocytes, as well as hepatic blood flow. In Japan, endoscopic injection sclerotherapy is often performed prophylactically in patients with high-risk esophageal varices. We examined the effects of blocking portosystemic shunts by this treatment on hepatic circulation and hepatocyte function as evaluated by 99mTc-GSA scintigraphy (HH15, LHL15), an examination via asialoglycoprotein receptors on hepatocytes. Methods: forty-nine patients who underwent prophylactic treatment of esophageal varices were divided into two groups; one having esophageal varices alone and the second having other collateral circulation in addition to esophageal varices. Asialoscintigraphy and general liver function tests were performed both before and after treatment in each group and the data were statistically analyzed. Results: In the group having esophageal varices alone, serum total bile acid significantly decreased at 62.2% and ICGR15, HH15, and LHL15 were slightly improved at -10.9, -3.0, and +4.7%, respectively, after sclerotherapy (P<0.01). However, Child-Pugh's score was not changed after sclerotherapy. In the group having additional collaterals, no parameters were changed after sclerotherapy. Conclusion: we demonstrate that HH15, LHL15, and ICGR15 are partially influenced by hepatic circulation but are mainly determined by the function of hepatocytes, whereas serum total bile acid is markedly influenced by hepatic circulation.

Journal Article↗
PubMedDate not supplied

Ruptured gastric fundal varices treated with endoscopic variceal ligation and transjugular retrograde obliteration: case report.

Therapeutic modalities for the obliteration of collateral vessels connecting the portal venous system with the systemic circulation, transjugular retrograde obliteration (TJO) and balloon-occluded retrograde transvenous obliteration have recently been developed, and several satisfactory results have been reported with their use. We report a case of ruptured gastric fundal varices treated with TJO after endoscopic variceal ligation (EVL). In our case, variceal bleeding was controlled successfully with EVL and varices were eradicated with TJO.

Adult↗
PubMed1995

Analysis of prognostic variables in the prediction of mortality, shunt failure, variceal rebleeding and encephalopathy following the transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage.

BACKGROUND/AIMS: The aim of this study was to analyse prognostic variables predicting mortality, shunt insufficiency, variceal rebleeding and encephalopathy following transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage. METHODS: Sixty-eight patients with cirrhosis who successfully underwent transjugular intrahepatic portosystemic stent-shunt for variceal haemorrhage were studied. Mean age was 54.8 years (s.e. 1.5); 41 were males and 27 were females. Mean Child score was 8.3 (s.e. 0.3). Cirrhosis was alcohol related in 47. The patients have been followed up for a mean of 10.8 (s.e. 1.1) months. The univariate association between 30 prognostic variables and post-treatment encephalopathy was tested by the Chi-squared or Wilcoxon rank-sum tests and multiple logistic regression was used to test the significance of factors adjusted for one another. Cox's proportional hazard regression was used to test the univariate and multivariate significance of the other three outcomes. RESULTS: Transjugular intrahepatic portosystemic stent-shunt was performed successfully in 89.5% of patients. Twenty-two patients have died and eight have been transplanted. Fourteen patients died within 30 days of transjugular intrahepatic portosystemic stent-shunt and death was predicted independently by hyponatraemia (p < 0.001) and by severe liver disease (Child C, p < 0.001). Eight patients died during follow up and survival in the long term was predicted independently by the presence of encephalopathy (p < 0.001) prior to transjugular intrahepatic portosystemic stent-shunt (p < 0.001). Shunt insufficiency was predicted by an initial portal pressure gradient of greater than 18 mmHg (p < 0.01). None of the variables analysed predicted variceal rebleeding. Encephalopathy following transjugular intrahepatic portosystemic stent-shunt was only predicted indepedently by its presence prior to transjugular intrahepatic portosystemic stent-shunt (p < 0.001). CONCLUSIONS: The results of this study suggest that patients with severe liver disease and hyponatraemia are liable to die early, and the presence of encephalopathy prior to transjugular intrahepatic portosystemic stent-shunt independently determines long-term survival. Patients in these groups should be considered high risk and worked up for orthotopic liver transplantation early. Shunt function in patients with an initial portal pressure gradient of > 18 mmHg requires close supervision. Encephalopathic patients should have smaller shunts and prophylactic measures to prevent worsening encephalopathy.

Esophageal and Gastric Varices↗
PubMed1997

A patient with gastric fundal varices and colonic varices due to splenic vein thrombosis.

We report a patient presenting with melena. Endoscopic examination showed gastric fundal varices as well as colonic varices. The latter is rarely encountered and is usually associated with portal hypertension. On angiography there appeared to be a splenic vein thrombosis which is only reported once earlier as a cause of colonic varices. A short review of the literature concerning colonic varices is added.

Colon↗
PubMed2001

Variceal band ligation in the management of bleeding oesophageal varices: an overview.

Endotherapy is, in many centres, still the cornerstone in the first-line approach of a patient with variceal haemorrhage. Since the introduction of the multiband ligation, devices, active variceal bleeding is controlled as efficiently as with sclerotherapy, and variceal eradication can be obtained much faster with fewer treatment-related complications. This observation is now supported by several randomized trials. Combining sclerotherapy with band ligation has no additional effect and can even increase the number of side-effects. Therefore, multiband ligation can be considered as a first-step treatment for bleeding oesophageal varices.

Esophageal and Gastric Varices↗
PubMed2006

Emergency endoscopic variceal ligation versus somatostatin for acute esophageal variceal bleeding.

BACKGROUND: Endoscopic variceal ligation and somatostatin are widely used for treating acute esophageal variceal bleeding. This study compared the efficacy, safety, and survival of both therapies. METHODS: Acute esophageal variceal bleeding patients were randomized to undergo emergency ligation or receive a bolus of 250 microg somatostatin plus infusion at 250 microg/hour for 48 hours and undergo ligation subsequently. RESULTS: Three (4.8%) of 62 patients in the ligation group and 20 (31.7%) of 63 patients in the somatostatin group encountered treatment failure (p = 0.0001). Transfusion requirements were 4.7 +/- 3.2 units in the ligation group and 6.9 +/- 7.3 units in the somatostatin group (p = 0.03). Hospital stay was 7.7 +/- 4.0 days in the ligation group and 10.2 +/- 9.9 days in the somatostatin group (p = 0.07). Adverse effects occurred in the ligation group (20 episodes) and the somatostatin group (27 episodes) (p = 0.2). The 42-day mortality rates were 5 patients (8.1%) in the ligation group and 3 patients (4.8%) in the somatostatin group (p = 0.5). CONCLUSION: Emergency ligation was superior to somatostatin in treating acute esophageal variceal bleeding, with fewer requirements of transfusion and a tendency toward shorter hospital stay. The adverse effects and 42-day mortality rates were similar between both treatments.

Acute Disease↗
PubMed1996

Double-blind randomized controlled trial comparing terlipressin and somatostatin for acute variceal hemorrhage. Variceal Bleeding Study Group.

BACKGROUND & AIMS: Terlipressin and somatostatin decrease portal pressure and have been used to treat variceal hemorrhage, but they have not been adequately compared. The aim of this study was to compare the efficacy and safety of these drugs in the treatment of variceal bleeding in cirrhotic patients. METHODS: Of 161 patients with variceal bleeding. 80 were randomized to receive (double-blind) intravenous terlipressin (2 mg/4 h) and 81 to receive somatostatin (continuous infusion of 250 micrograms/h after an intravenous injection of 250 micrograms). Success of therapy was defined as a 24-hour bleeding-free period within 48 hours from randomization. RESULTS: Success of therapy was similar with terlipressin (80%) and somatostatin (84%). In patients with Child's class A and B disease, terlipressin was effective in 52 of 60 (87%) and somatostatin in 48 of 55 (87%). Success rates in class C were 60% and 77% (P = 0.33). No differences were observed in rebleeding rates (30% vs. 28.4%) and 6-week mortality rates (13 vs. 13 patients). Incidence of side effects was significantly higher in the terlipressin group (38.8% vs. 23.5%; P = 0.042). Severe side effects requiring intervention occurred in 5 of 80 and 4 of 81 patients, respectively. CONCLUSIONS: Terlipressin and somatostatin are highly effective as first-line treatment of variceal hemorrhage in cirrhotic patients. The low incidence of severe side effects suggests that drug therapy may be maintained for longer periods to prevent early rebleeding.

Acute Disease↗
PubMed1987

Bleeding rectal varices following injection sclerotherapy of oesophageal varices in a child.

Bleeding from oesophageal varices accounts for most of upper gastrointestinal bleeding in children (4). Repeat injection sclerotherapy proved to be a practical and effective method to control the bleeding and obliterate the varices (5, 8). This report describes a 13-year-old girl with portal hypertension who developed massive rectal variceal bleeding after repeat injection sclerotherapy of oesophageal varices.

Adolescent↗
PubMed1983

Randomised, controlled study of transhepatic obliteration of varices and oesophageal stapling transection in uncontrolled variceal haemorrhage.

Percutaneous transhepatic obliteration and surgical stapling transection of the oesophagus with the EEA gun were compared prospectively in the treatment of uncontrolled oesophageal variceal haemorrhage unresponsive to conservative measures. Twenty patients with cirrhosis, with a patient portal vein and who were considered suitable for general anaesthesia and surgery, were randomised to two treatment groups (10 patients each). Immediate arrest of haemorrhage was achieved in 17 patients (nine surgery, eight obliteration). In one other patient, stapling transection succeeded where attempted transhepatic obliteration failed, and in another patient obliteration succeeded where attempted transection had failed. One patient continued to bleed and died following attempts at both procedures. Two other patients also died in hospital, without rebleeding following surgery. Variceal rebleeding during the same hospital admission occurred in two patients in the obliteration group and in none after surgery. Oesophageal stapling transection compares very favourably with a non-surgical technique such as transhepatic obliteration of varices in the emergency treatment of uncontrolled variceal haemorrhage in patients with moderate liver failure.

Adult↗
PubMed1992

[Results of non-decompression surgery for esophago-gastric varices--postoperative disappearance, recurrence, rebleeding rate of varices, and cumulative survival rate].

A total of 508 patients had an non-decompression surgery for esophago-gastric varices in our department, from September 1979 to December 1991. These patients consisted of 387 cases of transthoracic esophageal transection with para-esophagogastric devascularization, 40 cases of transabdominal esophageal transection, and 81 cases of Hassab procedure. The original diseases were cirrhosis in 432 patients, IPH in 35, extrahepatic-portal occlusion in 24, primary biliary cirrhosis in 6, Budd-Chiari syndrome in 4, and others in 7. Operative mortality rate was 5.3%. By thoracic approach, esophageal varices completely disappeared. Postoperative cumulative variceal recurrence and bleeding rates at 10 years were 12% and 7%, although recurrence occurred more often than not in cases with hepatocellular carcinoma (HCC). Cumulative survival rates at 5, 10 years were 69%, 46% in liver cirrhosis without HCC. Present study confirmed that our non-decompression surgery is effective in controlling esophagogastric varices in long term of periods.

Esophageal and Gastric Varices↗
PubMed2006

[Cost-effectiveness analysis of emergency endoscopic variceal ligation plus octreotide in the treatment of acute esophageal variceal bleeding in cirrhotic patients].

OBJECTIVE: To compare and evaluate the cost and effectiveness of endoscopic variceal ligation (EVL) at emergency plus octreotide versus octreotide alone in the treatment of acute esophageal variceal bleeding in cirrhotic patients. METHODS: Seventy-eight patients with active variceal bleeding under emergency endoscope, were assigned to two groups receiving either combined therapy of EVL at emergency and octreotide ('EVL' group) or a continuous infusion of octreotide alone ('octreotide' group). Both efficacy and cost-effectiveness were observed. RESULTS: There were no significant differences between the two groups in patients' characteristics, supporting treatment or general treatment. In group EVL, there appeared a significantly higher rate in controlling bleeding and lower complication rate than that of octreotide group(94.4% vs.78.6%, P = 0.045 and 19.4% vs. 42.9%, P = 0.027, respectively). Early rebleeding and mortality rate were also lower in group EVL, but with no significant differences between them (2.9% vs. 7.7%, P = 0.358 and 5.6% vs. 14.3%, P = 0.205, respectively). The combined therapy had a significantly shorter time of hemostasis, less administration of octreoid, fewer units of blood transfusion and shorter hospital stay (P < 0.001). The median costs of the combined therapy and octreotide alone were RMB 9046.5 Yuan and 13 743.6 Yuan,respectively (P = 0.045). The cost-effective ratio of group EVL seemed superior to that of octreoid group. CONCLUSION: The therapeutic scheme of emergency EVL plus octreotide was a more cost-effective one for controlling acute esophageal variceal bleeding.

Combined Modality Therapy↗
PubMed1991

A new approach to esophageal varices: endoscopic variceal ligation.

Bleeding from esophageal varices is a devastating complication of portal hypertension and is associated with a high mortality rate. The management goals for this group of patients are to achieve hemostasis in the acute phase, reduce variceal size, reduce the potential of rebleeding and eliminate varices with a follow-up program. For the past two decades, the gold standard of treatment has been endoscopic sclerotherapy but at the expense of many complications, which often cause serious morbidity. Endoscopic variceal ligation was developed as an alternative to endoscopic sclerotherapy. The experience to date shows that the goals of therapy can be achieved with fewer complications than those associated with sclerotherapy.

Endoscopy, Digestive System↗
PubMed1989

[Antral varices in a patient in sclerosing treatment of esophageal varices].

Descriptions of antral varices are very rare in the literature and there are no previous descriptions of this entity occurring after endoscopic sclerosis of esophageal varices. We present a 48-year-old patient with portal hypertension due to alcoholic liver cirrhosis in whom antral varices were demonstrated in the course of the fourth sclerotherapy session for his esophageal varices, when these had decreased dramatically in size. We review the radiological and endoscopic aspects.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Controversies and certitudes on the upper digestive hemorrhage through rupture of esophageal varices. II. The therapy of portal hypertension and of variceal bleeding.

The present-day therapy of portal hypertension and of variceal bleeding includes new drugs (propranolol, glypressin, somatostatin, a.o.) and methods of hemostasis (variceal sclerotherapy). This second part of a paper concerned with the upper digestive hemorrhage through rupture of the esophageal varices presents the main drug therapies and other various methods used to decrease the portal pressure, to achieve a direct hemostasis in case of active variceal bleeding and to prevent the rebleedings.

Catheterization↗