The Effect of Rabeprazole on Injection Sclerotherapy Complications after First Attack Bleeding Esophageal Varices

Background and study aim : Endoscopic variceal sclerotherapy (EVS) effectively controls bleeding esophageal varices (OV); however it has some adverse effects including sclerosant ulcers; chest pain; dysphagia and odynophagia. Gastric acid plays a central role in mediating and aggravating these complications. Proton pump inhibitors (PPI) are the most potent pharmacologic agents for inhibition of gastric acid secretion. Therefore; these agents are the logical candidates to combat the effects that gastric acid plays in post EVS complications. However; some authors still believe that there is no strong evidence to support their use. This study was designed to evaluate the effects of the use of PPI (rabeprazole) for 8 weeks after endoscopic sclerotherapy for first attack variceal bleeding on the prevention and treatment of complications after EVS. Moreover; we aim to assess the presence of any adverse effects for the use of this drug for this period in this specific patients group.Patients and methods: One hundred patients with first attack variceal bleeding were included in the study. They were allocated randomly into a test group which received 20mg rabeprazole once daily oral dose following endoscopic sclerotherapy starting 6 hours after injection sclerotherapy and continued for 2 months and a control group which did not receive rabeprazole after sclerotherapy. For both groups; endoscopic; laboratory and clinical data were monitored every two weeks for a period 2 months. Results: The test group had significantly lower frequency of all post sclerotherapy adverse symptoms; (dysphagia; odynophagia; heart burn; retrosternal and epigastric pain as well as dyspepsia) as well as lower overall rate of re-bleeding (14 vs 46 in the control group). There were no significant differences in the hematological parameters or endoscopic findings between test and control groups. Moreover; the use of the drug for two months was not associated with any significant infectious or non infectious complications including fever; hepatic encephalopathy; SBP; diarrhea and chest infection. Conclusion: Rabeprazole use decreases post-sclerotherapy symptoms and decrease the rate of rebleeding after sclerotherapy without any increasing the complications related to acid supression

Esophageal Stricture Post Endoscopic Injection Sclerotherapy

Background: Post endoscopic sclerotherapy esophageal stricture is usually not fatal but may requires several sessions of esophageal dilation as an effective palliative treatment yet has its own complications. Aim: The purpose of this study is to find out the predictors of sclerotherapy esophageal stricture. Methods: This is a cross sectional descriptive study of the esophageal stricture post sclerotherapy for the patients who were managed in the period from January 2000 through the June 2007 in endoscopic department at Ibn Sina Hospital. Post endoscopic sclerotherapy symptoms; signs; diagnostic and therapeutic methods were analysed to find out possible predictors of developing benign esophageal stricture. Result: A 33 out of 10133 patients who had sclerotherapyl were found to have esophageal stricture and were included in this study. 91of them were males; 88were 60years old and most of them were cases of hepatic periportal fibrosis. Only two patients had esophageal varices secondary to viral hepatitis B liver cirrhosis. Their presentation was commonly with difficulty in swallowing and few cases presented with food impaction. The majority of patients were treated with wire guided endoscopic Savary Gilliard dilation. Conclusion: Esophageal stricture following endoscopic injection sclerotherapy is a known morbidity; however the rate of these strictures is fairly acceptable. High dose of sclerotherapy in fewer sessions over a short period are potential predictors of esophageal stricture

Antegrade scrotal sclerotherapy versus inguinal microsurgical varicocelectomy in the treatment of varicocele ­ a prospective, randomized, parallel group study

Objective To evaluate the efficacy; safety and cost-effectiveness of antegrade scrotal sclerotherapy (ASS) compared to inguinal microsurgical varicocelectomy (IMV) for the treatment of varicocele of the testis. Patients and Methods Male patients above 13 years of age with grade 2 to 3 varicocele; who were either symptomatic or presented with an abnormal semen analysis; were included in the study. The patients were randomized in a ratio of 1:1 between ASS or IMV. ASS was performed using sodium tetradecyl sulphate (Fibro-veinr) as sclerosing agent in a 1and 3mixture. IMV was performed using an inguinal approach and microsurgery loupes during spermatic cord dissection to identify and preserve the testicular artery and lymphatics. Color doppler ultrasound was used to measure testicular volume and pampiniform vein diameter before treatment and at 6 and 12 month follow-up visits. Semen analysis was obtained at the same time intervals. The efficacy parameters included serum follicle stimulating hormone (FSH); luteinizing hormone (LH); semen analysis; pregnancy rate of partners and estimation of costs involved. Results Between April 2000 and December 2003; 25 patients were included in the study. ASS was performed on 12 patients (6 bilateral procedures) and IMV on 13 patients (2 bilateral). Obliteration of the clinically detectable varicocele was achieved in 10/12 patients in the ASS and in 11/13 in the IMV group (89and 87success rate; respectively). ASS was superior to IMV with regard to costs; average theatre time; hospitalization and postoperative recovery. Both procedures had a one year pregnancy rate of 50. The mean sperm count and mean sperm morphology improved significantly from baseline to 12 months in both groups. However; there were no statistically significant differences between the two methods with regard to semen analysis improvement; testicular volume or biochemical data (LH; FSH; testosterone). Serum FSH decreased in those who had successful treatment of their varicocele; but not in those with recurrence; although the difference was not statistically significant (p=0.09); probably due to the small patient numbers. Conclusion ASS is a minimally invasive treatment for varicocele; which is feasible as an out-patient procedure in adolescents and adults. It can save costs; theatre time; hospitalization and time lost from work. ASS and IMV appear to be equally successful in terms of varicocele recurrence; pregnancy rate and semen analysis improvement