Effect of intravariceal sclerotherapy combined with esophageal mucosal sclerotherapy using small-volume sclerosant for cirrhotic patients with high variceal pressure

Kong, Derun; Wang, Jinguang; Chen, Chen; Yu, Fangfang; Wu, Qiong; Xu, Jianming

doi:10.3748/wjg.v21.i9.2800

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…A review summarized the incidence of complications of EIS, including transient dysphagia (70%); retrosternal chest discomfort (65%); low-grade fever (6%–10%); esophageal stricture (8%–10%); esophageal perforation (0.5%); systemic embolization such as pulmonary embolism, portal thrombosis, and splenic thrombosis (0.5%–3%); esophageal ulceration of the injection site (60%); and bleeding ulcer (20%–30%) ( 24 ). Severe EIS-induced AEs due to extensive wall necrosis are mostly caused by incorrect injection techniques, an excessive amount of sclerosant injected, or the use of a highly concentrated sclerosant ( 13 , 20 ). However, EIS with a small-volume injection of sclerosant at each session could reduce the incidence rate of complications.…”

Section: Discussionmentioning

confidence: 99%

“…For patients in the EVL group, ligation was performed with a standard technique as previously described ( 8 ). For patients in the CAES group, lauromacrogol in a small volume was administered to thrombose the main variceal channels and thereby eradicate varices (as previously described ( 13 , 15 )) and was used as sclerosant. Briefly, patients received an injection of lauromacrogol along with a transparent cap, which was placed in front of the endoscope.…”

Section: Methodsmentioning

confidence: 99%

“…The advantages of repeated EVL over sequential therapy of EIS after EVL in the secondary prophylaxis of EVB are not well supported. It has been reported that the incidence rate of EIS-induced complications can be reduced with intravariceal or small-volume injection of EIS ( 13 , 14 ). Some studies have demonstrated that EIS may be better than EVL for treating EVs with small volumes ( 6 , 7 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

“…It has been reported that the incidence rate of EIS-induced complications can be reduced with intravariceal or small-volume injection of EIS ( 13 , 14 ). Some studies have demonstrated that EIS may be better than EVL for treating EVs with small volumes ( 6 , 7 , 13 ). The effectiveness of EIS is believed to depend on the duration of contact between the vascular endothelial cells and the sclerosant.…”

Section: Introductionmentioning

confidence: 99%

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Cap-Assisted Endoscopic Sclerotherapy vs Ligation in the Long-Term Management of Medium Esophageal Varices: A Randomized Trial

Wang

Xiao

Hong

et al. 2020

Clinical and Translational Gastroenterology

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INTRODUCTION: Compared with endoscopic variceal ligation (EVL), cap-assisted endoscopic sclerotherapy (CAES) improves efficacy in the treatment of small esophageal varices (EVs) but has not been evaluated in the management of medium EVs. The aim of this study was to compare CAES with EVL in the long-term management of patients exhibiting cirrhosis with medium EVs and a history of esophageal variceal bleeding (EVB), with respect to variceal eradication and recurrence, adverse events, rebleeding, and survival. METHODS: Cirrhotic patients with medium EVs and a history of EVB were divided randomly into EVL and CAES groups. EVL or CAES was repeated each month until variceal eradication. Lauromacrogol was used as a sclerosant. Patients were followed up until 1 year after eradication. RESULTS: In total, 240 patients (age: 51.1 ± 10.0 years; men: 70.8%) were included and randomized to the EVL and CAES groups. The recurrence rate of EVs was much lower in the CAES group than in the EVL group (13.0% vs 30.7%, P = 0.001). The predictors for variceal recurrence were eradication by EVL (hazard ratio [HR]: 2.37, P = 0.04), achievement of complete eradication (HR: 0.27, P < 0.001), and nonselective β-blocker response (HR: 0.32, P = 0.003). There was no significant difference in the rates of eradication, rebleeding, requirement for alternative therapy, and mortality or the incidence of complications between groups. DISCUSSION: CAES reduces the recurrence rate of EVs with comparable safety to that of EVL in the long-term management of patients presenting cirrhosis with medium EVs and a history of EVB.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cap-Assisted Endoscopic Sclerotherapy vs Ligation in the Long-Term Management of Medium Esophageal Varices: A Randomized Trial

Wang

Xiao

Hong

et al. 2020

Clinical and Translational Gastroenterology

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“…To date, esophageal and gastric variceal bleedings have been considered the major cause of upper gastrointestinal hemorrhage in cirrhotic patients, with a high risk of mortality and poor prognosis. It is therefore essential that patients who are with liver cirrhosis should not only receive intervetion to survive from acute variceal hemorrhage, but also undergo secondary prophylaxis (32). The advancements in multidisciplinary approaches that include pharmacological therapy, endoscopic intervention, transjugular intrahepatic portosystemic shunt and surgery have improved outcomes of cirrhotic patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of Preoperative Oral Carbohydrate on Cirrhotic Patients Under Endoscopic Therapy with Anesthesia: A Randomized Controlled Trial

Wang

Liu

et al. 2020

Preprint

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Background: Preoperative fasting is a major cause of perioperative discomfort in patients. Addressing this problem by preoperative oral carbohydrate (POC) has been recommended as an important element of the enhanced recovery after surgery (ERAS) protocol, but its effect on cirrhotic patients who tend to show abnormalities in gastric emptying function has not yet been clarified. Our study aims to investigate the influence of POC on gastric empting and preoperative well-being in cirrhotic patients. Methods: A prospective, randomized and controlled study of cirrhotic patients with gastroesophageal varices scheduled for elective endoscopic therapy under intravenous anesthesia was conducted. 180 patients were enrolled in this study. Patients were divided into three groups: those not supplement with carbohydrate for 8h prior to endoscopic therapy (Control group), those given a carbohydrate beverage 2h (2h group) or 4h (4h group) prior to endoscopy. Gastric emptying was evaluated by gastric sonography score and collecting gastric content aspirated endoscopically before anesthesia. Stresses caused by examination associated fasting were evaluated by visual analogue scale (VAS) scores for six parameters (thirst, hunger, mouth dryness, nausea, vomit and weakness) preoperatively. Hemodynamic changes, peristole and postoperative complications were also recorded. Results: Before anesthesia, gastric sonography score was similar among three groups. In addition, no patient had residual gastric volume more than 1.5ml/kg in control and 4h group, but six patients (11%) reached a residual gastric volume of more than 1.5ml/kg in 2h group. Moreover, compared with control fasting, VAS scores for six parameters (thirst, hunger, mouth dryness, nausea, vomiting and fatigue) in 2h group and for three parameters (thirst, hunger and mouth dryness) in 4h group were both significantly lower. Gastric peristaltic score and operation score before operation, postoperative complication, lengths of hospital stay and in-hospital expense were not significantly different among three groups.Conclusions: For the first time, we demonstrate that avoiding preoperative fasting with oral carbohydrates given 4h prior to anesthesia can improve preoperative well-being feelings, without enhancing the risk of aspiration and regurgitation in cirrhotic patients. Our study adds knowledge for preoperative fasting guidelines in anesthesia for cirrhotic patients. Trial registration: This trial was registered at Clinicaltrials.gov under the number ChiCTR2000032394.

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Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta-analysis

Torres

Best

Freeman

et al. 2021

Cochrane Database of Systematic Reviews

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Effect of intravariceal sclerotherapy combined with esophageal mucosal sclerotherapy using small-volume sclerosant for cirrhotic patients with high variceal pressure

Abstract: Intravariceal-mucosal sclerotherapy using small dose of sclerosant is more effective than EVL in decreasing the incidence of variceal recurrence for cirrhotic patients.

Cited by 7 publications

References 21 publications

Cap-Assisted Endoscopic Sclerotherapy vs Ligation in the Long-Term Management of Medium Esophageal Varices: A Randomized Trial

Cap-Assisted Endoscopic Sclerotherapy vs Ligation in the Long-Term Management of Medium Esophageal Varices: A Randomized Trial

Effects of Preoperative Oral Carbohydrate on Cirrhotic Patients Under Endoscopic Therapy with Anesthesia: A Randomized Controlled Trial

Secondary prevention of variceal bleeding in adults with previous oesophageal variceal bleeding due to decompensated liver cirrhosis: a network meta-analysis

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