Controlled trial of vasopressin plus nitroglycerin vs. vasopressin alone in the treatment of bleeding esophageal varices

Tsai, Yang‐Te; Lay, Chii-Shyan; Lai, Kwok‐Hung; Ng, Wai-Wah; Yeh, Yeong-Shyan; Wang, Jiin-Yu; Chiang, Teun-Tzong; Lee, Shou‐Dong; Chiang, Benjamin N.; Lo, Kwang‐Juei

doi:10.1002/hep.1840060313

Cited by 145 publications

(37 citation statements)

References 17 publications

(12 reference statements)

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“…Conventional measures therapy, including blood and frozen plasma transfusion, fluid and including balloon tamponade, vasoconstrictors, and surgical electrolytes replacement, and lactulose, was administered to patients intervention did not substantially improve survival. [1][2][3] In the in both groups as clinically indicated. Oximeter monitoring was roupast 2 decades, endoscopic injection sclerotherapy (EIS) has tinely performed for both treatment groups during endoscopic therbeen widely employed in the management of bleeding from apy.…”

Section: Tion Was Associated With a Lower Complication Rate Thanmentioning

confidence: 99%

Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices

et al. 1997

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acute variceal bleeding proved to be superior to vasoconstricActive bleeding varices are a great challenge to endostors or balloon tamponade in the control of hemorrhages. [5][6][7] copists. In this study, we compared the short-term effiNevertheless, substantial complications may be associated cacy and safety of banding ligation with injection sclerowith EIS. 8 Furthermore, while EIS has been used extentherapy in the arresting of active bleeding from sively, it also has not had a significant impact on survival.4 esophageal varices. Seventy-one cirrhotic patients with Endoscopic variceal ligation (EVL) has been adopted in recent active variceal bleeding were randomized to receive years to substitute for EIS in managing bleeding esophageal banding ligation (37 patients) or sclerotherapy (34 pavarices.9 tients) immediately after endoscopic examinations. PriMost controlled studies comparing EVL with EIS favored mary success rate (bleeding stopped for 72 hours) was EVL in terms of sessions required to achieve variceal oblitera-97% in the ligation group and 76% in the sclerotherapy tion, rebleeding rate, and complication rate. [10][11][12][13] On the other group (P Å .009). The efficacy of ligation was similar to hand, EIS and EVL were found to be of similar effectiveness sclerotherapy in the control of oozing varices (100% vs.in terms of arresting active bleeding. 14 However, all of those 89%, P Å .23), whereas ligation was superior to sclerostudies comprised only a small number of patients with active therapy in the control of spurting varices (94% vs. 62%, variceal bleeding. Thus, a larger study comparing EVL with P Å .012). The requirement of vasoconstrictors after EIS for the control of active variceal bleeding is mandatory. emergency endoscopic treatment was lower in the ligaThis study was undertaken to investigate the efficacy and tion group than in the sclerotherapy group (11% vs. 41%, safety of EIS and EVL in the control of active bleeding from P Å .007). Treatment failure within 1 month was 8% in esophageal varices. the ligation group vs. 30% in the sclerotherapy group (P Å .02). Blood transfusion requirements were signifi-PATIENTS AND METHODS cantly lower in the ligation group than in the sclerotherapy group (3.2 { 1.2 vs. 4.5 { 1.8 units, P õ .01). RebleedBetween October 1991 and June 1995, seventy-one consecutive ing rate within 1 month was 17% in the ligation group cirrhotic patients with active variceal bleeding admitted to Veterans and 33% in the sclerotherapy group (P Å .19). Significant General Hospital-Kaohsiung (Taiwan, Republic of China) were enrolled in the study. All of the patients were proven to be actively complications were encountered in 5% of the ligation bleeding from esophageal varices by emergency endoscopy within 12 group and 29% of the sclerotherapy group (P Å .007).hours of admission. Among them, emergency endoscopy was perMortality rates within 1 month were 19% in the ligation formed in forty-two patients within 6 hours of entry to the emergency group and 35% in the sclerotherapy gr...

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Section: Tion Was Associated With a Lower Complication Rate Thanmentioning

confidence: 99%

Emergency banding ligation versus sclerotherapy for the control of active bleeding from esophageal varices

et al. 1997

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“…Nitroglycerine used alone had poor results. However, a meta-analysis of three controlled trials using the combination of vasopressin and nitroglycerin versus vasopressin alone, showed a 19% improvement in control of bleeding when the combination was used (64 vs. 45%) [48][49][50]. ß-Blockers, particularly propranolol, have been used to reduce portal pressure prophylactically.…”

Section: Gastric Varicesmentioning

confidence: 99%

Extraesophageal Varices

Kotfila¹,

Trudeau²

1998

Dig Dis

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Esophageal varices are the most common site of variceal bleeding. However, bleeding from varices that are not located in the esophagus may account for up to 30% of all variceal bleeding. Significant varices can occur in the stomach, duodenum, jejunum, ileum, colon, rectum, and biliary tree. They can also occur at the site of a surgical ostomy. These types of varices bleed less commonly than esophageal varices, but they can also be far more difficult to diagnose and treat. The absence of stigmata of recent esophageal variceal bleeding and certain clues in the patient’s history and clinical presentation should raise the clinician’s suspicion of an extraesophageal site of variceal bleeding. Particularly, patients with extrahepatic causes of portal hypertension, cirrhotic patients with a prior history of gastrointestinal surgery, and patients who present with profound bleeding but without hematemesis need to be evaluated further if an obvious site of esophageal variceal bleeding is not seen on initial endoscopy. In this article, we review the features particular to extraesophageal varices as well as the diagnosis and management of bleeding from these varices. We use the term extraesophageal rather than ectopic because the term ectopic varices implies exclusion of both esophageal and gastric varices.

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“…Failure to control bleeding was significantly less common with vasopressin plus nitroglycerin (OR, 0.39 [95% CI, 0.21-0.72]), but there was no difference in mortality (OR, 0.94 [95% CI, 0.49-1.79]). In two of the trials [16,17], side effects were significantly reduced with the combination treatment. The recommended dose of vasopressin is 0.4 U/min, as an intravenous infusion; 4-hourly sublingual nitroglycerin should be prescribed simultaneously.…”

Section: Vasopressin (With and Without Nitroglycerin)mentioning

confidence: 99%

“…This drug is a powerful venous dilator and hence reduces the portal vascular resistance and improves myocardial performance. Three randomised controlled trials have compared vasopressin alone with vasopressin plus nitroglycerine (transdermally [15], sublingually [16], and intravenously [17]), including 176 patients (table 1). Failure to control bleeding was significantly less common with vasopressin plus nitroglycerin (OR, 0.39 [95% CI, 0.21-0.72]), but there was no difference in mortality (OR, 0.94 [95% CI, 0.49-1.79]).…”

Section: Vasopressin (With and Without Nitroglycerin)mentioning

confidence: 99%