A study on management of hemorrhoids: Comparison between conservative management and injection sclerotherapy

Background: Hemorrhoidal disease is one of the most common anorectal conditions encountered in daily practice for centuries. Conservative management of hemorrhoids (with oral diosmin, calcium dobesilate cream local application) and injection sclerotherapy with 3% polidocanol-both are very commonly practiced, cost effective, and outpatient department-based management of hemorrhoids which bear rare adverse effects. Comparative efficacy of injection sclerotherapy and conservative management in cases of hemorrhoids is still confusing and contradictory to each other according to different studies. Aims and Objectives: This study was conducted to compare the effectiveness between conservative management of hemorrhoids and injection sclerotherapy. Materials and Methods: This institution-based experimental study done over 74 patients of first- and second-degree internal hemorrhoids. Thirty-seven patients were randomly selected and managed with conservative management, and the rest with injection sclerotherapy. Treatment responses were assessed after 3 weeks and in unsatisfactory responses, treatment was repeated for another 3 weeks. Reassessment was done after 6 weeks and 6 months. Results: This study demonstrated that both injection sclerotherapy and conservative management had improved per rectal bleeding after 3 and 6 weeks of treatment, but the former had a significant edge over the counterpart after 6 months of treatment (56.8% vs. 35.1%, P = 0.002). In case of reduction of hemorrhoidal mass – injection sclerotherapy had significantly better outcome in all the follow-up visits, that is, 3 weeks (54.1% vs. 13.5%, P = 0.001), 6 weeks (70.3% vs. 35.1%, P = 0.008) and 6 months (59.5% vs. 27.0%, P = 0.003). Injection sclerotherapy had superior overall treatment outcome after 6 weeks of treatment (73% vs. 45.9%, P = 0.04) and long-term periods (56.85% vs. 27%, P < 0.01). Conclusion: Injection sclerotherapy shows significantly better and long-lasting improvement in symptomatic hemorrhoids in comparison to conservative management which is mainly able to limit per rectal bleeding only for a short period of time.

Advances in the treatment of infantile hemangiomas of the larynx / 临床耳鼻咽喉头颈外科杂志

Infantile hemangiomas are relatively common soft tissue tumors in infants and young children, with a prevalence of about 4.5% in full-term newborns. Subglottic Hemangioma （SGH） is a relatively rare type of hemangioma, and its special location often causes respiratory distress and potentially life-threatening conditions in infants. Therefore, it is necessary for clinicians to make an accurate diagnosis and formulate a detailed treatment plan based on the clinical manifestations, the auxiliary examinations, the medical history and the vital signs evaluation of patients.This review describes the pathophysiological mechanism of infantile hemangioma and provides a detailed discussion on commonly used treatment methods in detail.

Clinical value of regular endoscopic treatment for esophageal and gastric variceal bleeding in patients with liver cirrhosis / 中华消化内镜杂志

Objective:To evaluate the regular endoscopic therapy for esophageal and gastric variceal bleeding (EGVB) in patients with liver cirrhosis.Methods:A total of 305 patients of EGVB with liver cirrhosis who received endoscopic hemostasis in Nanjing Drum Tower Hospital between January 2015 and January 2018 were included in the retrospective cohort study. Patients were divided into the regular endoscopic treatment group ( n=145) and the irregular endoscopic treatment group ( n=160). The primary outcome measure was rebleeding rate, and the secondary outcome measures were follow-up time, rebleeding interval and rebleeding mortality. Results:There were no significant differences between the two groups in terms of gender composition, average age, etiology composition, the cause of disease under or out of control, liver reserve function, or administration of non-selective β-blockers ( P>0.05), and the baseline data were comparable. The rebleeding rate was 11.7% (17/145) in the regular endoscopic treatment group and 41.9% (67/160) in the irregular endoscopic treatment group ( χ2=38.74, P<0.001). The follow-up time, rebleeding intervals and mortalies of rebleeding in the regular endoscopic treatment group and the irregular endoscopic treatment group were 28.14±11.11 months and 21.10±12.37 months ( t=5.21, P<0.001), 12.0 (6.0, 23.0) months and 1.0 (1.0, 6.0) months ( U=164.00, P<0.001), and 1.4% (2/145) and 10.6% (17/160) ( χ2=11.13, P=0.001), respectively. Conclusion:Compared with irregular endoscopic treatment, regular endoscopic treatment of EGVB in patients with liver cirrhosis has more clinical significance, which can significantly reduce the rebleeding rate, prolong the rebleeding interval, and reduce the mortality of rebleeding.

A randomized control trial of balloon compression-assisted endoscopic injection sclerotherapy for esophageal varices / 中华消化内镜杂志

Objective:To investigate the clinical efficacy and safety of balloon compression-assisted endoscopic injection sclerotherapy (bc-EIS) for esophageal varices in patients with cirrhosis.Methods:From December 2020 to April 2021, cirrhotic patients with esophageal varices who planned to receive endoscopic treatment in the Department of Gastroenterology of the First Affiliated Hospital of Anhui Medical University were selected and randomly divided into the trial group (treated with bc-EIS) and the control group [treated with endoscopic variceal ligation (EVL)] through computer randomization. The varices eradication rate, rebleeding rate and postoperative adverse reactions in the two groups were studied.Results:During the study, 93 cases were initially included according to inclusion criteria, among which 9 cases were excluded by exclusion criteria. Finally, 84 cases were included for data analysis, with 42 cases in each group. The esophageal varices eradication rate after the first treatment in the trial group was 88.10% (37/42), which was significantly higher than that in the control group [33.33% (14/42)] ( χ2=26.40, P<0.001). The esophageal varices eradication rate after 1 to 2 times and 1 to 3 times of treatment in the trial group were both significantly higher than those in the control group [97.62% (41/42) VS 40.48% (17/42), χ2=29.47, P<0.001; 100.00% (42/42) VS 45.24% (19/42), P<0.001]. The maximum follow-up period was 6 months, and none of the patients had rebleeding in the trial group, and the rebleeding rate in the control group was 4.76% (2/42) ( P=0.494). The incidence of thoracic and abdominal discomfort, nausea and vomiting, and abdominal distension in the trial group and control group were 26.19% (11/42) and 35.71% (15/42) ( χ2=0.51, P=0.474), 2.38% (1/42) and 7.14% (3/42) ( χ2=0.26, P=0.608), and 4.76% (2/42) and 11.90% (5/42) ( χ2=0.62, P=0.430), respectively. No other adverse events such as infection, dysphagia, perforation, esophageal tracheal fistula, esophageal stenosis, or ectopic embolism occurred in any group. Conclusion:Bc-EIS is effective and safe for the treatment of esophageal varices in patients with cirrhosis, with a one-time varices eradication rate of more than 85%, and can be completely eradicated after 1 to 3 times of treatment.

Effects of diabetes on rebleeding after endoscopic treatment in liver cirrhosis patients with esophageal varices / 中华消化内镜杂志

Objective@#To investigate whether combined diabetes affects rebleeding after endoscopic treatment in cirrhosis patients with esophageal varices.@*Methods@#A total of 207 liver cirrhosis cases with esophageal varices bleeding who underwent initial treatment of endoscopic variced ligation or endoscopic injection sclerotherapy in the First Affiliated Hospital of Anhui Medical University from June 2015 to March 2018 were included in the retrospective study. The cases were divided into bleeding group (n=54) and non-bleeding group (n=153) according to the presence or absence of rebleeding within 6 months after treatment. The influencing factors on postoperative bleeding were analyzed by univariate analysis and logistic regession analysis.@*Results@#Univariate analysis showed that gender composition, age, presence or absence of portal vein thrombosis, smoking history, drinking history (P=0.05), hypertension, platelet count, total bilirubin level, albumin level, alanine aminotransferase level, prothrombin time, degree of esophageal varices, and surgical methods were not significantly different (all P≥0.05) between the bleeding group and the non-bleeding group. There were significant differences in diabetes, hemoglobin level, blood glucose level, ascites composition, and liver function grade composition between the two groups (all P<0.05). Combined diabetes (yes/no), hemoglobin levels, blood glucose levels, ascites (none-mild/medium-severe), liver function Child-Pugh classification (Grade A/B-C), and history of drinking (yes/no) were included in multivariate analysis, and results showed that diabetes was an independent risk factor for rebleeding after endoscopic treatment of esophageal varices (P=0.008, OR=2.973, 95%CI: 1.322-6.689).@*Conclusion@#After endoscopic treatment of liver cirrhosis patients with esophageal varices, rebleeding is more likely to occur in patients complicated with diabetes.

Risk factors analysis of early rebleeding after endoscopic treatment of esophageal varices / 中华消化内镜杂志

Objective To investigate the risk factors of early rebleeding after endoscopic treatment of esophageal varices. Methods A retrospective analysis was performed on the clinical data of 384 cirrhotic patients with esophageal varices. The factors of early rebleeding group[n=36(9.4%)]and non?bleeding group(n=348)were compared by single factor analysis and multivariate analysis of Logistic regression. Results Single factor analysis showed that there were differences between the two groups in cirrhosis with hepatocellular carcinoma, Child?Pugh classification, Child?Pugh score, ascites volume, portal vein thrombosis, portal vein width, portal hypertensive gastropathy, shapes and numbers of varicose veins, numbers of varicose vein ligation, varicose vein red syndrome, albumin, total bilirubin, prothrombin time, prothrombin activity and platelet number. Further multivariate analysis showed that mass ascites(P=0.000, OR=7.614,95%CI: 3.590?16.147), portal vein thrombosis(P=0.003, OR=2.867, 95%CI: 1.429?5.750),portal hypertensive gastropathy(P=0.000, OR=6.212, 95%CI: 3.036?12.711), and Child?Pugh C(P=0.008,OR=3.078,95%CI:1.338?7.083)were independent risk factors of early rebleeding after endoscopic treatment. Conclusion The early rebleeding rate was high after endoscopic treatment of esophageal varices. Patients with massive ascites,portal vein thrombosis,portal hypertensive gastropathy and Child?Pugh C should be highly vigilant for early rebleeding.

Clinical analysis of esophageal submucosal hematoma caused by endoscopic injection sclerotherapy: 5-cases-report and literature review / 中国内镜杂志

Objective To study the etiology clinical features, treatment outcomes and prevention of esophageal submucosal hematoma caused by endoscopic injection sclerotherapy (EIS) of esophageal varices. Methods We retrospectively reviewed the clinical data of patients who were diagnosed with esophageal submucosal hematoma caused by EIS and treated in our hospital from Jan 2014 to July 2016. Five patients were analyzed including one patient receiving endoscopic gastrointestinal catheterization combined with medication, and the remaining four received medication therapy only. Results All five patients were discharged with clinical improvement. However the patients treated only with medication therapy recovered more slowly than the ones who treated with combined therapy. No treatment related side-effects were observed among two treatment groups. Conclusion Endoscopic gastrointestinal catheterization combined with medication may be an effective treatment for esophageal submocasal hematoma caused by EIS. However, the actual clinical efficacy and safety remain to be proven by future large sample randomized clinical studies.

The Clinical Value of Ultrasound-Guided Percutaneous Lauromacrogol Injection Sclerotherapy for Simple Renal Cyst / 中国生化药物杂志

Objective To analyze the clinical value of ultrasound-guided percutaneous Lauromacrogol Injection sclerotherapy in the treatment of simple renal cyst. Methods A total of eighty patients with simple renal cyst, who were divided into 40 groups according to the random number table, were divided into two groups from February 2016 to April 2017. The traditional group used traditional open renal cyst unroofing decompression. Ultrasound guided ultrasound guided percutaneous Lauromacrogol Injection sclerotherapy was performed in the ultrasound guided group. The therapeutic effect, operation time and the rate of successful puncture were compared between two groups of simple renal cysts. It needs to compare the volume of the cyst and the quality of life before and after the intervention. Results Ultrasound guided group simple renal cyst treatment effect was higher than the traditional group (P<0.05). The operation time of the ultrasound guided group was shorter than that of the traditional group, and the success rate of the one shot puncture was higher than that of the traditional group(P<0.05). Before the intervention, the volume and quality of life of the two groups were similar. In the ultrasound guided group, the volume and quality of life in the ultrasound guided group were better than those in the traditional group(P<0.05). Conclusion Ultrasound guided percutaneous Lauromacrogol Injection sclerotherapy is of high clinical value in the treatment of simple renal cysts. The utility model can improve the success rate of one puncture, shorten the operation time, and the exact effect can speed up the regression of symptoms and reduce the volume of the cyst. Therefore, this method can improve the quality of life of patients.

Using Sengstaken-Blakemore tube as assist treatment of escophageal and gastric variceal bleeding under emergency endoscopy / 中国内镜杂志

Objective To evaluate the effect of Sengstaken-Blakemore tube in assisting cyanoacrylate injection combined with sclerotherapy and variceal ligation under emergency endoscopy in treating escophageal and gastric variceal bleeding. Methods 60 patients were randomly selected, and were evenly divided into 2 groups single blindly. Endoscopic cyanoacrylate injection, sclerotherapy and variceal ligation were performed in control group, and additional Sengstaken-Blakemore tube were used in experimental group. Results All the 30 patients in study group got effective hemostasis (30 of 30, 100.00 %), whereas only 23 patients in control groups stopped bleeding (23 of 30, 76.67 %) (P < 0.05). escophageal and gastric variceal were cured 19 patients in the experimental group (19 of 30, 63.33 %) , and only 4 were cured in the control group (4 of 28, 14.28 %) (P < 0.05). Meanwhile, occurence of fever, chest pain, hospital days and hospitalization costs of experimental group was significantly lower than that in control group (P < 0.05). Conclusions Treating the escophageal and gastric variceal bleeding, using endoscopic cyanoacrylate injection, sclerotherapy; and variceal ligation under emergency endoscopy combined with Sengstaken-Blakemore tube could significantly increase the therapeutic efficiency as well as reduce complications and therapy cost.

Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report / 대한간학회지

Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.

Portal and Mesenteric Venous Thrombosis Complicating Endoscopic Injection Sclerotherapy / 대한소화기내시경학회지

Endoscopic injection sclerotherapy is an effective and relatively safe modality for controlling bleeding esophageal varices. Injection of sclerosant causes acute mural thrombosis with a necroinflammatory response and subsequent sclerosis in the venous system of the distal esophagus. A few cases of mesenteric venous thrombosis with small bowel infarction after sclerotherapy have been reported, and most of which were fatal. The association between mesenteric venous thrombosis and sclerotherapy has been strongly suggested, but this still remains unproved. We report here on a case of mesenteric venous thrombosis with small bowel infarction that developed after endoscopic injection sclerotherapy.

A Case of Bleeding from a Periampullary Duodenal Varix that Developed after Biliary Metal Stent Placement in a Patient with Pancreatic Cancer / 대한소화기내시경학회지

Duodenal varices bleed less commonly than gastro-esophageal varices in patients with portal hypertension. However, if there is no stigmata of recent esophageal or gastric variceal bleeding, clinicians should suspect the presence of an extra gastro-esophageal site of variceal bleeding. Duodenal variceal bleeding can be difficult to diagnose and treat. Therefore, the bleeding may be life threatening in most cases and has a poor prognosis. We experienced a case of variceal bleeding that developed in a patient with far advanced pancreatic cancer after placement of a self- expanding metal stent into a strictured bile duct via the peroral and transpapillary route. The patient had a duodenal varix near the major papilla and the bleeding was treated with an injection of Histoacryl(R). We thought the bleeding of the periampullary varix resulted from injury due to exposure to the free end of the alloy wires in the distal portion of the inserted biliary metal stent.

Duodenal Variceal Bleeding Treated with a Combination of Endoscopic Ligation and Injection Sclerotherapy: Two Case Reports and a Review of the Korean Clinical Literature / 대한소화기내시경학회지

A duodenal varix is a rare cause of hemorrhage in patients with intrahepatic and extrahepatic portal hypertension. However, bleeding in these patients is serious and often life threatening. Treatments for duodenal variceal bleeding include endoscopic injection sclerotherapy, endoscopic ligation, surgical procedures and interventional radiology. We report two cases of duodenal variceal bleeding in a 53- year-old male patient and a 63-year-old female patient with liver cirrhosis that presented with hematemesis and melena. Emergency upper endoscopy examinations revealed the presence of large nodular varices with ruptured erosion on the top of the second portion of the duodenum. A combination of the use of endoscopic ligation and endoscopic injection sclerotherapy was performed and successful hemostasis and eradication of duodenal varices was possible in all cases. Another 19 cases of duodenal variceal bleeding that have been reported in the Korean clinical literature were reviewed.

A Case of Successful Endoscopic Injection Sclerotherapy with N-butyl-2-cyanoacrylate for Ruptured Duodenal Varices / 대한소화기학회지

Duodenal varix is a rare cause of hemorrhage in patients with portal hypertension, however their rupture is serious and often life threatening. Treatments for duodenal variceal bleeding include endoscopic procedures, surgery, or interventional radiologic procedures. We report a case of duodenal varices rupture in a 45-year-old man with alcoholic liver cirrhosis who presented with melena and dizziness. Emergent upper endoscopy revealed large nodular varices with a ruptured erosion on the top in the distal second portion of duodenum. Two consecutive injections with 1.0 mL of n-butyl-2-cyanoacrylate (Histoacryl; Braun-Melsungen, Germany) mixed with 1.0 mL of lipiodol (Laboratoire-Guerbet, France) were performed intravariceally and achieved successful hemostasis. This suggests that endoscopic injection sclerotherapy with histoacryl may be an effective therapeutic option for the control of ruptured duodenal variceal bleeding.

Endoscopic variceal ligation-injection sclerotherapy (EVLIS) for gastric varices: Analysis of 10 years' experience / 대한내과학회지

BACKGROUND: The aim of this study is to evaluate the long-term clinical outcome, rebleeding rate, and recurrence rate of endoscopic variceal ligation injection sclerotherapy (EVLIS) for gastric varices. METHODS: 302 cases were chosen from patients treated with EVLIS for gastric varices from September 1992 to August 2002. The follow-up period ranged from 6 to 12 months with average being 35 months. RESULTS: The number of patients with gastric varices F1, F2, F3 were 105 (43.8%), 127 (42%), 70 (23.2%) and Lg-c, Lg-f, Lg-cf were 82 (26.9%), 67 (22.2%), 153 (50.9%). The average sessions of therapy needed for the initial hemostasis was 2.34 times. Initial hemostasis in 117 patients who needed emergency treatment was successfully done in all cases. Early rebleeding was observed in 36 (12%) patients in whom most of the bleeding occurred from the secondary ulcer. Late rebleeding was observed in 37 (12.2%) patients in whom secondary ulcer and gastric variceal bleeding accounted for rebleeding in 14 (4.6%) patients and 23 (7.6%) patients respectively. Within the follow-up period, recurrence of gastric varices was observed in 104 (34.3%) patients with the average time to recurrence being 18.8+/-16 months. CONCLUSION: Since our method shows similar results with that of long-studied esophageal variceal therapy, it is thought of as an excellent treatment modality for gastric varices.

Changes in portosystemic collaterals after endoscopic injection sclerotherapy: focused on magnetic resonance angiography / 대한내과학회지

BACKGROUND: This study was aimed at evaluating the changes of collateral circulation, using MR angiography (MRA), which is a non-invasive and a useful tool for viewing the porto-systemic circulation as a whole, following endoscopic injection sclerotherapy (EIS). METHODS: 30 patients who have portal hypertension with esophageal varices have taken MRA before the sclerotherapy and followed up 1 month after the eradication. RESULTS: The collaterals observed before EIS are as follows: left gastric vein 30 patients (100%), short gastric vein 2 patients (7%), gastro-renal shunt 2 patients (7%) and spleno-renal shunt 6 patients (20%). After the sclerotherapy, left gastric vein was obliterated in 12 patients (40%), decreased to 25% and 50% in 9 patients (30%) but, no change in 6 patients (20%), increased in 3 patients (10%). For short gastric vein, 25% and 50% size reduction was found in 2 patients. For gastro-renal shunt, no change in size was observed in 1 patient, increased to 25% in 1 patient. For spleno-renal shunt, it disappeared in 1 patients (17%) and decreased to 25% in 1 patient but, no change in 3 patients (50%), increased to 25% in 1 patients. CONCLUSION: Obliteration of left gastric vein was observed in many cases after the sclerotherapy and further evaluation is needed.

A Case of Successful Endoscopic Injection Sclerotherapy with N-butyl-2-cyanoacrylate for Bleeding Duodenal Varices Misdiagnosed Initially / 대한소화기내시경학회지

Duodenal varices are a rare site of hemorrhage in patients with intrahepatic and extrahepatic portal hypertension, but their bleeding is life-threatening complication. Diagnosis of duodenal varices may be difficult, requiring careful inspection of the duodenal bulb during endoscopy. Diagnosis of duodenal varices may also be revealed using angiography and transhepatic portography. Treatment of duodenal varices include endoscopic injection sclerotherapy (EIS), endoscopic variceal ligation (EVL), surgical procedures, and interventional radiology. A 50-year-old woman with liver cirrhosis was admitted with melena and hematochezia. An endoscopy on admission showed esophageal and fundal varices without any bleeding stigma. Colonoscopy showed moderate amount of fresh blood in the terminal ileum. 99mTc-labelled RBC scan showed a suspicion of a distal jejunal bleeding. She had explo-laparotomy of small bowel segmental resection based on 99mTc-labelled RBC but rebleeding occured. Selective mesenteric angiography failed to reveal the source of bleeding. Repeat endoscopy revealed undetected duodenal varix which was covered with fresh blood clots. Endoscopic injection sclerotherapy with n-butyl-2-cyano acrylate (Histoacryl) was performed and achieved succesful hemostasis.

Diagnosis and Treatment of Varicose Veins

Varicose veins are dilated, tortuous veins exhibiting reflux because of valvular insufficiency. Dilatation of veins may be primary, that is, initiated by an unknown process, or may be the result of postthrombotic changes, arteriovenous fistula, or diverted flow resulting from a blockade of deep veins. Theoretical causes of varicose veins are heredity, race, gender, posture, gravitational back pressure, pregnancy, hormonal influence, weight, primary and secondary valvular incompetences, incompetent perforating veins, arteriovenous communications, and vein wall weakness. Visual inspection and palpation permit a clinical classification with respect to many different factors, especially the type of varix and the clinical stage of chronic venous insufficiency. Refluxes play a decisive role in the pathogenesis of large varices. They are usually detected over the sapheno femoral junction or the saphenopopliteal junction. Identification of these refluxes needs Doppler ultrasonographic techniques. Highly effective noninvasive examination methods have become available and include photoplethysmography, air plethysmography, portable Doppler ultrasound, and duplex scanning. The sole invasive diagnostic technique is ascending or descending phlebography. Several different treatments have been recommended for varicose veins. Flush ligation combined with stripping, avulsion of local varicosities, and perforator interruption are still the most common surgical techniques. The aim of varicose vein surgery is the removal of diseased incompetent vein segment and the control of reflux. Development of new sclerosing agents renders sclerotherapy for varicose veins more effective, and use of Doppler and the duplex ultrasound techniques provides a better hemodynamic and anatomic precision, which ultimately improves the treatment efficacy. Because patients seek treatment for varicose veins most commonly for cosmetic reasons, recently developed lasers and intense pulsed light(IPL) have become the methods for treating telangiectasia. In summary, surgery treats the major venous reflux, sclerotherapy treats the feeding venous system, and the laser or IPL seals effectively the superficial vessels.

Emergent sclerotherapy in massive hemorrage from esophagogastric varices / 中华消化内镜杂志

Objective To evaluate the effective of emergent endoscopic injection sclerotherapy ( EIS) for lethal bleeding from esophagogastric varices. Methods In this study, endoscopic injection of 5% sodium morrhuate was used to control esophagogastric variceal bleeding in 176 patients. In all 209 cases, 181 cases suffered from acute lethal bleeding from esophagogastric varices received endoscopic variceal sclerotherapy under the modified Senstaken-Blakemore tube compression. Results The exact bleeding site at the first procedure could be visualized in 166(94. 3% ) patients. The effective rate of EIS was 96. 2% . Multiple procedures were required in the 21 cases of relapsed bleeding. Complications of EIS occurred in 15 cases (8. 5% ) , of which 3(1. 7% ) died. Conclusion Endoscopic injection sclerotherapy under the modified Senstaken-Blakemore tube compression is relatively safe and effective procedure in the treatment of lethal bleeding from esophagogastric varices.

The Influence of EIS or EVL to Gastric Varices in Bleeding Esophageal Varices / 대한소화기내시경학회지

Background: Esophageal variceal hemorrhage is the most life threatening complication of portal hypertension secondary to chronic progressive liver disease such as liver cirrhosis. Recently, endoscopic injection sclerotherapy(EIS) and endoscopic variceal ligation(EVL) have been known to be the most effective, simple and safe methods. Gastric varices are sometimes associated with esophageal varices in patients with portal hypertension. However the role of endoscopic sclerotherapy in the treatment of gastric varices has not been adequately evaluated, and the fate of coexisting gastric varices after eradication of esophageal varices is not clearly known. Methods: EIS or EVL was preformed in 174 patients with variceal hemorrhage in CHUNG-NAM NATIONAL UNIVERSITY HOSPITAL from September 1990 to December 1993. Among the total 174 patients, 50 patients were followed for at least 1 year. Forty four patients were treated with EIS, and 6 witb EVL. We assesed the influence of EIS or EVL on coexisting gastric varices and the development of gastric varices after EIS or EVL in 50 patients.