Prospective Controlled Trial of Injection Sclerotherapy in Patients With Cirrhosis and Recent Variceal Hæmorrhage

Clark, Amanda; Westaby, David; Silk, D. B. A.; Dawson, J. L.; Macdougall, B.R.D.; Mitchell, Kara; Strunin, L.; Williams, Roger

doi:10.1016/s0140-6736(80)91990-x

Cited by 143 publications

(28 citation statements)

References 9 publications

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“…There have, however, now been encouraging randomized controlled studies showing a significant reduction in rebleeding rate and mortality following sclerotherapy. 1,4,25 In a controlled study, MacDougall et al 4 showed that instances of rebleeding rate of 90% 1 in conservatively managed most of the rebleeds (20 of 22) occurred in the first 3 months, before complete ablation had been achieved. Their 1-year survival increased from 58% in the control group to 75% in the sclerotherapy group.…”

Section: Discussionmentioning

confidence: 99%

“…Our major complication rate of 4.5% compares well with that in the literature. 1,6 Most of the complications occurred early in the reported period. In 2 of 5 patients with stenosis, dysphagia persisted after adequate dilatation, undoubtedly due to lower esophageal motor disturbances.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Sixty percent of hospitalized patients with bleeding esophageal varices initially controlled by conservative measures will rebleed and 60% of those who rebleed will die during their first hospital admission. 1,7,8 Sclerotherapy was introduced in 1939 9 to combat the problem but was quickly abandoned in favor of portosystemic shunting, which remained the treatment of choice for the next 30 years. However, it became evident that the low incidence of rebleeding following shunt operations occurred at the expense of a high perioperative mortality and postoperative morbidity mainly from portosystemic encephalopathy and liver failure.…”

Section: Introductionmentioning

confidence: 99%

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Sclerotheraphy for Esophageal Varices: A Retrospective Study of 61 Patients Treated at King Faisal Specialist Hospital

et al. 1984

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Over a period of 36 months, 61 patients underwent sclerotherapy for esophageal varices, 49 after a variceal bleeding episode (Group I) and 12 selected patients prophylactically (Group II). Mean follow-up was 12.6 months in Group I and 15.5 months in Group II. In Group I 27% died; only 10% of those patients presenting with mild liver disease (Child's Group A) who were followed died of gastrointestinal hemorrhage; but all presenting with severe liver disease (Child's Group C) died after a mean of 6.3 months, 57% following rebleeding. No patients in Group II died from esophageal hemorrhage. The rebleeding risk per patient-month of follow-up was 0.04 in Group I, 0.005 in Group II and 0.01 in the 22% of patients in Group I who achieved complete ablation of their varices. There was no mortality attributable to the procedure, and complications occurred after only 4.5% of the procedures; all were reversible. Sclerotherapy seems at present the treatment of choice for bleeding esophageal varices, considering its efficacy, safety and simplicity. It is probably also of value prophylactically in selected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sclerotheraphy for Esophageal Varices: A Retrospective Study of 61 Patients Treated at King Faisal Specialist Hospital

et al. 1984

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“…Pierwsze wyniki badań z randomizacją wykazujących skuteczność skleroterapii w uzyskaniu hemostazy i poprawie przeży-cia opublikowano we wczesnych latach 80. XX w. [69][70][71]. Wśród najczęściej stosowanych środków obliterujących wymienia się: 1-procentowy polidokanol, 5-procentowy oleinian etanoloaminy, 3-procentowy siarczan sodowy tetradecylu (sodium tetradecyl sulfate -STD), alkohol absolutny, hipertoniczną glukozę i 3-procentowy fenol (tab.…”

Section: Endoskopowa Skleroterapia Iniekcyjnaunclassified

Management of variceal haemorrhage

Wróblewski¹,

Dâbrowski²

2010

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StreszczenieŻylaki przełyku są bardzo poważnym powikłaniem nadciśnie-nia wrotnego, którego najczęstszą przyczyną jest marskość wątroby. Krwawienie z żylaków przełyku często ma dramatyczny przebieg, może nawracać i wiąże się ze znaczną śmier-telnością. Dzięki aktualnie stosowanym metodom leczenia śmiertelność związana z krwawieniem w ostatnich 2 dekadach zmniejszyła się o połowę, z 40% do ok. 20%. Stało się tak dzięki lepszemu zrozumieniu mechanizmów prowadzą-cych do wzrostu ciśnienia wrotnego oraz udoskonaleniu metod leczenia farmakologicznego, endoskopowego i radiologicznego. Nowoczesne leczenie krwawienia z żylaków przełyku powinno uwzględnić miejsce jego prowadzenia -oddział intensywnego nadzoru, ostrożną stabilizację hemodynamiczną, skuteczne leczenie zakażenia, zastosowanie leków obniżających ciśnienie wrotne. Kluczową rolę odgrywa terapia endoskopowa, gdzie metodą z wyboru jest opaskowanie, a alternatywą skleroterapia. Istotne znaczenie ma profilaktyka nawrotu krwawienia oraz profilaktyka pierwszego krwawienia. W przypadku niepowodzenia leczenia endoskopowego i farmakologicznego alternatywą jest TIPS (transjugular porto-systemic shunt) i dotyczy to zarówno leczenia ostrego krwawienia, jak i profilaktyki wtórnej. AbstractOesophageal varices are a very severe complication of portal hypertension which is mainly caused by hepatic cirrhosis. Variceal bleeding often has a dramatic course, may recur and is associated with substantial mortality. Thanks to the currently used methods of treatment, in the last two decades the mortality rate due to bleeding has decreased by half, from 40 to 20%. This was possible owing to better understanding of the mechanisms that cause an increase in portal hypertension, and thanks to improvement in pharmacological, endoscopic and radiological treatments. The modern management of oesophageal variceal bleeding should take into consideration the place of treatment -the intensive care unit, cautious haemodynamic stabilization, effective treatment of infection and administration of drugs reducing portal pressure. Endoscopic therapy plays a fundamental role, with variceal band ligation being the treatment of choice and injection sclerotherapy as an alternative option. Very important are rebleeding prevention and primary bleeding prophylaxis. When endoscopic and pharmacological treatments fail, transjugular porto-systemic shunt (TIPS) is an alternative both for the treatment of acute bleeding and as secondary prophylaxis. WprowadzenieŻylaki przełyku są częstym i bardzo groźnym powikła-niem nadciśnienia wrotnego, które cechuje się wzrostem ciśnienia w obrębie żyły wrotnej powyżej 12 mm Hg. Ponieważ bezpośredni pomiar ciśnienia w żyle wrotnej oraz określenie prawidłowego zakresu ciśnień w układzie wrotnym są trudne, jako kryterium nadciśnienia wrotnego przyjmuje się gradient ciśnień między żyłą wrotną a żyłą główną dolną (ang. hepatic venous pressure gradient -HVPG) większy niż 5-10 mm Hg. Najczęstszą przyczyną nadciśnienia wrotnego, bo aż w ok. 90% przypadków, jest marskość wątroby (klasyf...

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“…10 Terblanche et al in 1979 and Clark et al in 1980 published 2 controlled trials showing that sclerotherapy was effective in preventing recurrent bleeding from varices. 11,12 Their observations, plus improvements in the flexible endoscope, established sclerotherapy as an effective method for the treatment of acute and recurrent bleeding from varices. Surgical shunts were an established method for the control of recurrent bleeding in patients who had bled at least once from varices.…”

Section: Year 1980mentioning

confidence: 99%

Pharmacologic treatment of portal hypertension: Past, present, and future

Boyer

2001

Hepatology

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Prospective Controlled Trial of Injection Sclerotherapy in Patients With Cirrhosis and Recent Variceal Hæmorrhage

Cited by 143 publications

References 9 publications

Sclerotheraphy for Esophageal Varices: A Retrospective Study of 61 Patients Treated at King Faisal Specialist Hospital

Sclerotheraphy for Esophageal Varices: A Retrospective Study of 61 Patients Treated at King Faisal Specialist Hospital

Management of variceal haemorrhage

Pharmacologic treatment of portal hypertension: Past, present, and future

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