A comparison of sclerotherapy with staple transection of the esophagus for the emergency control of bleeding from esophageal varices

Article Abstract:

Esophageal varices are twisted veins which form as a result of high blood pressure originating in the liver. These vessels can open and bleed, creating an emergency situation. Treatment in the emergency room is aimed at stopping the bleeding with transfusion and drugs. Sclerotherapy, the injection of chemicals that cause tissue hardening, is used to stop bleeding blood vessels in esophageal varices. In 101 cases of cirrhosis of the liver and variceal bleeding where routine treatment had failed, sclerotherapy and another emergency treatment using a staple gun to section off bleeding vessels were compared for efficacy. The rate of death following the two procedures was similar: after six weeks, 44 percent of the patients treated with sclerotherapy died, compared with 35 percent of those undergoing staple transection. It was found that the use of staple transection of bleeding blood vessels offered better and longer results than a single sclerotherapy injection in treating bleeding varices. A third sclerotherapy injection was administered in 11 cases, but was able to control bleeding in only two of them, and nine died. It is recommended that surgery be performed after two sclerotherapy injections have failed to control variceal bleeding.

Health aspects, Surgery, Esophagus, Esophageal surgery

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Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices

Article Abstract:

Esophageal ligation may be more effective than endoscopic sclerotherapy for treatment of cirrhosis patients with bleeding esophageal varices, or dilated veins. Of 129 cirrhosis patients with a history of bleeding from esophageal varices, 65 were treated with endoscopic sclerotherapy, and 64 were treated with esophageal ligation. Fourteen patients in the ligation treatment group were bleeding, and ligation stopped the bleeding in 12. Thirteen of the patients in the sclerotherapy group were bleeding, and the treatment stopped the bleeding in 10. Forty-eight percent of patients treated with sclerotherapy had recurrent bleeding, compared with 36% of those treated with ligation. Elimination of varices required an average of four treatments among patients treated with ligation, and an average of five among those treated with sclerotherapy. Complications occurred among 22% of patients in the sclerotherapy group, compared with two percent of those in the ligation group. Forty-five percent of patients treated with sclerotherapy died, compared with 28% of patients treated with ligation.

Usage, Ligature (Surgery)

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Primary prevention of bleeding from esophageal varices

Article Abstract:

It may be too early to recommend changing the practice of giving the drug propranolol to patients with esophageal varices. Esophageal varices are large, dilated veins that have a high risk of bleeding. They are commonly seen in patients with liver cirrhosis. Propranolol is an inexpensive and safe beta blocker that can reduce the risk of bleeding in these patients. A 1999 study found that endoscopic ligation was better than propranolol in preventing bleeding. In this procedure, small rubber bands are placed around the veins. However, there was no difference in mortality rates between the two groups of patients.

Editorial, Evaluation, Prevention, Propranolol hydrochloride, Propranolol, Endoscopic surgery

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