Endoscopic Sclerotherapy for Esophago-Gastric Varices.

Objectives: To determine role of histoacryl injection in preventing upper acute upper gastrointestinal bleeding. Study Design: Prospective Study. Setting: Gastroenterology ward of DHQ Teaching Hospital Gujranwala. Period: One year from 1st September 2017 to 31st August 2018. Material & Methods: Patients presented to the study hospital having upper gastrointestinal bleeding of acute onset due to gastric varices bleeding were included in this study. All other cases having upper GIT bleeding due to other causes like peptic ulcer disease, Mallory weise syndrome, gastritis or esophageal varices were not included in this study. Both male and female patients were included irrespective of their age. Hemostasis in these cases was achieved by endoscopic sclerotherapy using histoacryl glue (N-butyl-2-cyanoacrylate) injection without lipoidal dilution. After first session of injection patients were called on follow up after 5 days and they were assessed for recurrent GIT bleeding and treatment failure. All data was documented on a predesigned performa. Frequencies and percentage were calculated and results were expressed in tabular form and graphs. Results: Total 80 cases were studied including 56% male and 44% female cases. Endoscopic sclerotherapy using histoacryl injection proved successful in 87.5% cases and recurrent bleeding occurred in 12.5% cases. Minimum age of patients was 25 years and maximum age 70 years with mean age of 45 years. Total 450 cases presented in study institution with Upper GIT bleeding during study period and causes among them were liver cirrhosis in 92% cases, peptic ulcer disease in 4% cases, Malloryweise Syndrome in 2.5% and gastritis in 1.5% cases. In our study group cause of gastric varices was liver cirrhosis due to viral hepatitis in 73% cases and alcoholic hepatitis in 27% cases. After single session of endoscopic histoacryl glue injection to 80 cases, no bleeding occurred after 5 days in 71(88.7%) cases, recurrent bleeding occurred within 5 days in 9(11.2%) cases. Two cases died due to massive recurrent bleeding and mortality rate was 2.5%. Conclusion: Endoscopic sclerotherapy using Histoacryl injection is very successful treatment for acute upper gastrointestinal bleeding with very low recurrence rate of bleeding and low mortality rate.

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Terlipressina: profilo farmacologico clinico, terapeutico e farmacoeconomico nel trattamento delle varici esofagee

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v6i1.821 ◽

2005 ◽

Vol 6 (1) ◽

pp. 57-68

Author(s):

Lorenzo Pradelli

Keyword(s):

Medical Personnel ◽

Gastric Varices ◽

Endoscopic Sclerotherapy ◽

Variceal Hemorrhage ◽

Pharmacological Agents ◽

Endoscopic Techniques ◽

Drug Of Choice ◽

Cirrhotic Patients

The formation and rupture of esophageal and gastric varices are severe but common complications of hepatic cirrhosis. They represent the cause underlying more than one forth of all deaths in cirrhotic patients and exact an impressive burden in terms of survival, quality of life and health care resource consumption. Therapeutic options for the control of active variceal hemorrhage comprise pharmacological agents, endoscopic techniques and surgery. Of these, the only options immediately available in the absence of highly specialized medical personnel are vasoactive drugs, namely vasopressin and derivatives and somatostatin and derivatives. Despite this clear advantage, the role of pharmacological treatment is still debated; furthermore, there’s no consensus on the drug of choice for variceal bleeding control. In this paper the main pharmacological and clinical features of terlipressin, a synthetic vasopressin analog, are outlined, as well as a frame for its pharmacoeconomical evaluation. Terlipressin is the only vasoactive drug that demonstrated survival benefits in cirrhotic patients with active variceal hemorrhage, even in those treated with endoscopic sclerotherapy, and is characterized by a favorable risk/benefit ratio. The relative cost-effectiveness of the different drugs, nevertheless, is yet to be determined by methodologically rigorous studies, partly because at the present state of the research there still are clinical and economical uncertainties to be cleared.

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Prospective randomized trial of endoscopic sclerotherapy versus variceal band ligation for esophageal varices: influence on gastropathy, gastric varices and variceal recurrence

Journal of Hepatology ◽

10.1016/s0168-8278(97)80248-6 ◽

1997 ◽

Vol 26 (4) ◽

pp. 826-832 ◽

Cited By ~ 155

Author(s):

Shiv K. Sarin ◽

Anwrag Govil ◽

Ajay K. Jain ◽

Rajkumar C. Guptan ◽

Sanjeev K. Issar ◽

...

Keyword(s):

Randomized Trial ◽

Esophageal Varices ◽

Gastric Varices ◽

Prospective Randomized Trial ◽

Endoscopic Sclerotherapy ◽

Band Ligation ◽

Variceal Recurrence

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Emergency Endoscopy in Patients with Portal Hypertension Having Upper Gastrointestinal Bleeding

Tropical Doctor ◽

10.1177/004947559702700112 ◽

1997 ◽

Vol 27 (1) ◽

pp. 31-34

Author(s):

S P Misra ◽

M Dwivedi

Keyword(s):

Portal Hypertension ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Gastric Varices ◽

Oesophageal Varices ◽

Endoscopic Sclerotherapy ◽

Emergency Endoscopy ◽

Acute Upper Gastrointestinal Bleeding ◽

Upper Gastrointestinal ◽

Definite Role

During the last 4 years, 147 patients suffering from portal hypertension with acute upper gastrointestinal bleeding were subjected to emergency endoscopy soon after they were resuscitated. Seventeen (11.5%) patients were referred to us with a clinical diagnosis other than portal hypertension. The causes of bleeding as seen during endoscopy were: oesophageal varices ( n = 130; 88%), gastric varices ( n =11), gastric ulcer ( n = 2) portal hypertensive gastropathy ( n = 2) and erosive gastritis and duodenal ulcer in one patient each. All patient bleeding from oesophageal varices except one underwent emergency endoscopic sclerotherapy. One hundred and twenty-one (94%) stopped bleeding immediately. Rebleeding was seen in 11% and was effectively controlled by a second session of sclerotherapy in all but one patient. Twenty (14%) patients died. It is concluded that emergency endoscopy has a definite role in the management of patients with portal hypertension complicated by gastrointestinal bleeding.

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Non-cirrhotic portal hypertension: current concepts and modern management

Bangladesh Medical Journal ◽

10.3329/bmj.v43i3.26313 ◽

2016 ◽

Vol 43 (3) ◽

pp. 170-176

Author(s):

Md Ismail Patwary ◽

Matiur Rahman ◽

Kaushik Mojumder

Keyword(s):

Portal Hypertension ◽

Portal Vein ◽

Variceal Bleeding ◽

Gastric Varices ◽

Idiopathic Portal Hypertension ◽

Endoscopic Sclerotherapy ◽

Cyanoacrylate Glue ◽

Portal Fibrosis ◽

Vascular Origin ◽

Glue Injection

Non-cirrhotic portal hypertension (NCPH) is a heterogeneous group of liver disorders of vascular origin, leading to portal hypertension (PHTN) in the absence of cirrhosis.The lesions are generallyvascular, either in the portal vein, its branches or in the peri-sinusoidal area. The majority of diseases included in the category of NCPH are well-characterized disease entities where PHTN is a late manifestation. Two diseases that present only with features of PHTN and are common in developing countries are non-cirrhotic portal fibrosis (NCPF) and extrahepatic portal vein obstruction (EHPVO). Non-cirrhotic portal fibrosis is a syndrome of obscure etiology, characterized by obliterative-portovenopathy leading to PHT, massive splenomegaly and well-tolerated episodes of variceal bleeding in young adults from low socioeconomic backgrounds, having near normal hepatic functions. In some parts of the world, NCPFis called idiopathic portal hypertension in Japan or hepatoportalsclerosisin USA. Because 8595% of patient with NCPF and EHPVO present with variceal bleeding, treatment involves management with endoscopic sclerotherapy (EST) or variceal ligation (EVL). These therapies are effective in approximately 9095% of patients. Gastric varices are another common cause of upper gastrointestinal bleeding in these patients and these can be managed with cyanoacrylate glue injection or surgery. The prognosis of patients with NCPF is good and 5 years survival in patients in whom variceal bleeding can be controlled has been reported to be approximately 95100%.Bangladesh Med J. 2014 Sep; 43 (3): 170-176

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Cyanoacrylate pulmonary embolism after endoscopic sclerotherapy of gastric varices

Einstein (São Paulo) ◽

10.31744/einstein_journal/2021ai5778 ◽

2021 ◽

Vol 19 ◽

Author(s):

Julliana dos Santos Frassei ◽

Camila Soares Franco ◽

Vinicius Roeffero Brambilla ◽

Bruna Melo Coelho Loureiro ◽

Carolina dos Santos Kiebert ◽

...

Keyword(s):

Pulmonary Embolism ◽

Gastric Varices ◽

Endoscopic Sclerotherapy

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Pulmonary Glue Embolism: An unusual complication following endoscopic sclerotherapy for gastric varices

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.2018.18.02.020 ◽

2018 ◽

Vol 18 (2) ◽

pp. 231 ◽

Cited By ~ 2

Author(s):

Philips G. Michael ◽

Georgios Antoniades ◽

Anca Staicu ◽

Shahid Seedat

Keyword(s):

Distress Syndrome ◽

Gastric Varices ◽

Royal Infirmary ◽

Unusual Complication ◽

Endoscopic Sclerotherapy ◽

Respiratory Compromise ◽

Large Size ◽

Portosystemic Shunting ◽

Life Threatening ◽

High Degree

A pulmonary glue embolism is an unusual but potentially life-threatening complication following the treatment of variceal bleeding, especially in patients with large varices requiring large volumes of sclerosant. Other contributory factors include the rate of injection and ratio of the constituent components of the sclerosant (i.e. n-butylcyanoacrylate and lipiodol). This condition may be associated with a delayed onset of respiratory compromise. Therefore, a high degree of clinical suspicion is essential in patients with unexplained cardiorespiratory decline during or following endoscopic sclerotherapy. We report a 65-year-old man who was admitted to the Hull Royal Infirmary, Hull, UK, in 2017 with haematemesis and melaena. He subsequently developed acute respiratory distress syndrome secondary to a glue embolism following emergency sclerotherapy for bleeding gastric varices. The aetiology of the embolism was likely a combination of the large size of the gastric varices and the large volume of cyanoacrylate needed. After an endoscopy, the patient underwent transjugular intrahepatic portosystemic shunting twice to control the bleeding, after which he recovered satisfactorily.Keywords: Gastric Varices; Pulmonary Embolism; Sclerotherapy; N-butyl-cyanoacrylate; Lipiodol; Case Report; United Kingdom.

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