Endoscopic Injection Therapy Research Articles

Comparison of haemostatic efficacy for endoscopic injection therapy of epinephrine and combination therapy of epinephrine and hemoclips for bleeding peptic ulcers

Endoscopic injection therapy of epinephrine is safe and effective in the treatment of bleeding peptic ulcer, but with high risk of rebleeding. The combination therapy of epinephrine and hemoclips could lead to a reduction of rebleeding and a potential reduction in mortality. To investigate the efficacy and safety of epinephrine injection therapy and combination therapy with epinephrine and hemoclips in treating bleeding peptic ulcers. A prospective randomized study included 58 patients with bleeding gastric or duodenal ulcer. In 30 patients endoscopic injection therapy with diluted epinephrine was applied (group I), while in 28 patients combination therapy of epinephrine and hemoclips was applied (group II). RESULTS; Initial haemostasis was achieved in most patients treated with epinephrine injection therapy (93.3%) and patients treated with combination therapy of epinephrine and hemoclips (96.4%). After initial haemostasis was achieved rebleeding was significantly more frequent in the patients treated with epinephrine (28.5%) than in the patients treated with combination therapy (3.7%, p < 0.05). Two patients treated with epinephrine injection therapy were subjected to surgical intervention, whereas no patient treated with combination therapy needed surgery. Lethal ending occurred in one patient treated with epinephrine and in one patient treated with combination therapy. The difference between the two groups of patients in need for surgical intervention and mortality was not statistically significant. Combination therapy with epinephrine and hemoclips is more efficient than epinephrine alone in the treatment of bleeding peptic ulcers.

Successful endoscopic needle knife therapy combined with topical doxycycline injection of chronic sinus at ileal pouch-anal anastomosis

Aim Chronic presacral sinus at the anastomosis after restorative proctocolectomy and ileal pouch–anal anastomosis (IPAA) has been difficult to manage and results in a high rate of pouch failure. The aim was to present a novel technique with a combining endoscopic doxycycline injection and needle knife therapy for a sinus at the ileoanal anastomosis. Methods We applied repeat Doppler ultrasound-guided endoscopic needle knife therapy to open the orifice of the anastomotic sinus followed by topical injection of doxycycline. Results After six sessions of the endoscopic therapy, the refractory sinus was completely healed. Conclusion The Doppler ultrasound guided endoscopy therapy may provide an alternative treatment option for the patients with anastomotic sinus.

Editorial Comment

Lower urinary tract dysfunction with primary vesicoureteral reflux is recognized as a major risk factor for recurrent urinary tract infection, 1 Dias C.S. Silvia J.M. Diniz J.S. et al. Risk factors for recurrent urinary tract infections in a cohort of patients with primary vesicoureteral reflux. Pediatr Infect Dis J. 2010; 29: 2139-2144 Crossref Scopus (39) Google Scholar as well as for failure of open or endoscopic surgery. The authors outline their experience with endoscopic treatment of vesicoureteral reflux in a select group of children with symptoms of overactive bladder (OAB)—urgency or urge incontinence. All patients were toilet trained at diagnosis and had initially received a course of behavior modification, with anticholinergic medication in some cases, and 10% had failed previous dextranomer (Dx)/hyaluronic acid (HA) injection. Using the hydrodistension injection technique method, the overall success rate was commendable at 83%. The authors injected an 18% greater volume of Dx/HA in those children whose OAB symptoms were ongoing at endoscopic surgery and achieved a marginally greater (+8.7%) success rate, on early postoperative voiding cystourethrogram (VCUG) at 6-12 weeks, compared to those whose OAB symptoms had been eradicated preoperatively. After successful Dx/HA injection, the incidence of urinary tract infection was low, and 40% of the children with preoperative well-controlled OAB returned to normal voiding patterns. Is Endoscopic Injection Therapy a Reasonable Treatment Option for Low-grade Vesicoureteral Reflux in Association With Overactive Bladder?UrologyVol. 78Issue 3PreviewTo assess the clinical outcome of endoscopic injection in children with vesicoureteral reflux (VUR) and concomittant overactive bladder (OAB). Full-Text PDF ReplyUrologyVol. 78Issue 3PreviewWe agree that our study carries some limitations, including the lack of urodynamic data and objective criteria for categorizing the voiding symptoms and overactive bladder (OAB). Given our study's retrospective nature, our analysis was dependent on the information available from the chart review. Full-Text PDF

Is Endoscopic Injection Therapy a Reasonable Treatment Option for Low-grade Vesicoureteral Reflux in Association With Overactive Bladder?

To assess the clinical outcome of endoscopic injection in children with vesicoureteral reflux (VUR) and concomittant overactive bladder (OAB). A total of 41 patients with VUR and OAB underwent endoscopic injection of dextranomer/hyaluronic acid. At surgery, 13 patients had been successfully treated for their OAB (urgency with or without wetting) with behavior modification with or without anticholinergic therapy, and 28 had persistent OAB despite treatment. Voiding cystourethrogram was obtained 6-12 weeks postoperatively, and patients were followed up clinically for 1-5 years. Negative voiding cystourethrogram findings after a single treatment were seen in 34 (82.9%) of 41 patients. The radiographic success rate in patients with well-controlled OAB was 76.9% (10 of 13) compared with 85.7% (24 of 28) of those with poorly controlled OAB. The overall clinical success rate, defined as no evidence of urinary tract infection in the setting of negative voiding cystourethrogram findings, reached 78.0% (32 of 41). After successful endoscopic treatment, an unanticipated return to normal voiding patterns without the need for postoperative anticholinergic therapy was seen in 4 of the children with well-controlled OAB (40.0%) and in 4 with poorly controlled OAB (16.7%). Our data suggest that endoscopic injection is a viable treatment option for VUR in those with OAB, with postoperative rates of resolution comparable to those found in patients without OAB. Furthermore, 40.0% of children with well-controlled OAB no longer required therapy for OAB after resolution of their VUR.

Peripapillary Duodenal Varices as a Rare Cause of Severe Bleeding in a Patient with No Other Signs of Portal Hypertension – Successful Endoscopic Treatment with Cyanoacrylate Injection

Duodenal varices (DVs) are a rare cause of upper gastrointestinal bleeding and rather suspected in patients with portal hypertension. Bleeding DVs are difficult to manage and often fatal due to delayed diagnosis. We report on a 71-year-old patient with massive upper gastrointestinal haemorrhage, who did not show any clinical signs of portal hypertension; however, he had a history of duodenal segmental resection 8 years before. The source of bleeding could not be detected with different imaging methods such as angiography and computed tomography. Upper gastrointestinal endoscopy finally revealed DVs, which were located just adjacent to the papilla. After endoscopic injection therapy with n-butyl 2-cyanoacrylate the bleeding stopped immediately and the patient soon stabilised. Despite the peripapillar localisation no signs of pancreatitis or cholestasis occurred; during 10-month follow-up a marked regression of the varices without further signs of variceal bleeding was observed.

Intramural hematoma: a rare complication of endoscopic injection therapy for bleeding peptic ulcers

Intramural hematoma: a rare complication of endoscopic injection therapy for bleeding peptic ulcers

Effect of endoscopic injection therapy with combined cyanoacrylate and lipiodol for bleeding gastric varices: A single center experience

To evaluate the safety and efficacy of the endoscopic injection therapy with combined cyanoacrylate and lipiodol for bleeding gastric fundal varices. The medical records of cirrhotic and non-cirrhotic patients who underwent at least one episode of endoscopic application of N-butyl-2-cyanoacrylate-lipiodol mixture for gastric varices at our gastroenterology clinic between October 2004 and January 2010 were reviewed. The technique comprised the dilution of 0.5 mL of cyanoacrylate with 0.5 mL of lipiodol and repeating intravariceal injections of 1.0 mL each until hemostasis was achieved. A total of 66 patients (41 male and 25 female) with gastric varices underwent 86 endoscopic injections of cyanoacrylate for hemostasis. Overall 38 patients (57.6%) had active bleeding during the endoscopic procedure, while the remaining 28 (42.4%) underwent cyanoacrylate under elective conditions. In one patient (1.5%) hemostasis could not be achieved, prompting referral for emergency surgery. The median number of sessions was one (range 1-3). Eleven patients (16.6%) rebled during a median follow-up period of 6.02 months (0.1-62.4 months). There was no bleeding-related death. One patient developed splenic infarction a day after N-butyl-2-cyanoacrylate injection. Endoscopic injection therapy combining cyanoacrylate and lipiodol is effective for bleeding gastric fundal varices.

Management of an esophageal metallic stent obstructed by tumor progression: endoscopic alcohol injection therapy instead of restenting

Management of an esophageal metallic stent obstructed by tumor progression: endoscopic alcohol injection therapy instead of restenting

Long-term effect of endoscopic injection therapy with combined cyanoacrylate and ethanol for gastric fundal varices in relation to portal hemodynamics

The understanding on the long-term effect of endoscopic therapy for gastric fundal varices (FV) is still insufficient. The aim of this study was to evaluate the relationship between the long-term effect of the endoscopic injection therapy with combined cyanoacrylate (CA) and absolute ethanol (ET) for FV, and the portal hemodynamics. The subjects of this retrospective study were ten consecutive cirrhotic patients with bleeding FV treated by endoscopic injection therapy with combined CA and ET. Percutaneous transhepatic portography was done after the completion of endoscopic treatment to assess portal hemodynamics. All the patients showed hemostasis by CA injection and complete obturation of FV by combined therapy of 5.6 +/- 2.1 (3-9) times without any severe complications except for gastric ulcer in one case. Five patients had recurrence (50%), and three of them showed rebleeding (30%). The other five patients had no recurrence during a mean observation period of 5.58 years (1190-2735 days). Although recurrence did not correlate with portal venous pressure, it was significantly frequent in patients without advanced portosystemic collateral vessels (5/7, P = 0.0384) compared to patients with them (0/3). Endoscopic injection therapy combining CA and ET may be effective for FV. Significant development of portosystemic collateral vessels would support long-term therapeutic effect after this treatment.

Portal and splenic vein occlusion complicating Histoacryl injection therapy in bleeding gastric varices

Endoscopic injection therapy with n-butyl-2-cyanoacrylate (NBCA) (Histoacryl®, B. Braun, Melsungen, Germany) is an effective hemostatic treatment for gastric variceal bleeding [1]. In this report we describe a case of portal and splenic vein occlusion after injection therapy with NBCA.

Endoscopic injection therapy for a bleeding exposed vessel in Crohn's disease

Endoscopic injection therapy for a bleeding exposed vessel in Crohn's disease

Effective Injection Site on Endoscopic Injection Therapy for Postsphincterotomy Bleeding: Apex or Oral?

Effective Injection Site on Endoscopic Injection Therapy for Postsphincterotomy Bleeding: Apex or Oral?

Effective Injection Site on Endoscopic Injection Therapy for Postsphincterotomy Bleeding: Apex or Oral?

Effective Injection Site on Endoscopic Injection Therapy for Postsphincterotomy Bleeding: Apex or Oral?

Successful endoscopic sclerotherapy for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol

Two patients with liver cirrhosis and portal hypertension related to hepatitis infection were admitted to Shanghai Ruijin Hospital due to recurrent melena and hematemesis. Isolated gastric varices were observed in the gastric fundus during the retroflexion of gastroscope. We carried out endoscopic sclerotherapy successfully for bleeding gastric varices with combined cyanoacrylate and aethoxysklerol, which disappeared dramatically several months after two courses of sclerotherapy for each patient. No complication and clinical signs of gastrointestinal re-bleeding were observed during the 6-mo endoscopic follow-up. CT portal angiography (CTPA) has been widely used in the assessment of variceal treatment and improves the results of endoscopic injection therapy.

A Case of Gastric Bezoar Causing Ileal Obstruction During Treatment with Coca-Cola

Gastric bezoars are usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Recently, the efficacy of nasogastric lavage or endoscopic injection therapy with Coca-Cola has been reported. But the complication like intestinal obstruction has poorly been reported. We report a case of gastric bezoar causing ileal obstruction during treatment with oral administration and endoscopic injection of Coca-Cola. A 53-year-old man was referred because of epigastric pain for a day. He had a history of subtotal gastrectomy with gastroduodenostomy since 8 years ago. On upper gastrointestinal endoscopy, about 6cm sized, dark-greenish hard bezoar was impacted at gastric antrum and about 3-5cm sized three bezoars were found at body. We injected Coca-Cola into the bezoar through the endoscopy and the patient was instructed to drink four liters of Coca-Cola per day. On the 12th day of admission, the patient complained severe abdominal pain. On plain abdominal X-ray and CT scan, small bowel obstruction at proximal ileum with bezoar was suspected and exploration was performed. About 4cm sized two bezoars were impacted at proximal ileum, and small bowel resection with primary closure after removal of bezoar was performed. The patient was discharged on the 10th postoperative day without any complication.

Endoscopic injection therapy for post-sphincterotomy bleeding: single injection orad to the papilla versus double injection orad to and into the papilla

Endoscopic injection therapy for post-sphincterotomy bleeding: single injection orad to the papilla versus double injection orad to and into the papilla

Endoscopic treatment of reflux: management pros and cons

The goal of this review is to contrast the issues in favor of and against the use of endoscopic injection therapy in an attempt to highlight the current state of flux and draw attention to areas that merit further research. Current publications have mostly addressed the expanding use of endoscopic injection therapy for vesicoureteral reflux treatment, generally reporting short-term success rates and endpoints. This growing body of literature is presented in the context of perceived benefits vs. disadvantages in comparison with other available treatment modalities. The management of vesicoureteral reflux has changed dramatically in the past decade, mostly because of the increasing acceptance of endoscopic injection therapy as an adequate, minimally invasive, and effective form of therapy. Recent advances in the composition of injectable materials have allowed for easier placement with a perceived favorable safety profile. In particular, dextranomer/hyaluronic acid has become the injectable material of choice, with quick acceptance and widespread use soon after its introduction in different countries. As we critically evaluate the evolving treatment options, the presented literature helps draw attention to some of the challenges we face and the need for long-term and carefully planned prospective studies to support our interventions.

Modified Bladder Neck Reconstruction in Patients With Incontinence After Staged Exstrophy/Epispadias Closures

Reconstruction of the urethra without adequate circumferential muscular support is a significant problem in bladder neck surgery for urinary incontinence. Fascial, muscular and artificial slings have been used for support of the bladder neck after reconstruction. We used a demucosalized detrusor muscle pedicle to wrap around the bladder neck base along with other continence techniques in children who experienced incontinence after staged closure of exstrophy and epispadias. We describe our experience using the pedicle wraparound along with the Mitchell modification of Young-Dees-Leadbetter bladder neck reconstruction. We reviewed our continence rates using a detrusor wraparound in 8 eligible patients with failed staged exstrophy-epispadias repair. We defined incontinence as any degree of leakage through the bladder neck day or night. Of the 8 patients studied 2 were female and 6 were male. Mean patient age at surgery was 7.6 years (range 4 to 11). Mean followup was 3.2 years (range 0.5 to 5). All patients with staged exstrophy-epispadias repair failure are currently continent. Five patients underwent simultaneous bladder augmentation. All but 2 patients catheterize via a Mitrofanoff channel. Three patients void volitionally and 5 use clean intermittent catheterization per Mitrofanoff. Two patients required dextranomer/hyaluronic acid injections at the bladder neck postoperatively to achieve complete dryness. The detrusor bladder neck wraparound, while successful, may require concomitant surgery, including augmentation, clean intermittent catheterization and endoscopic injection therapy, to achieve continence following failure of staged exstrophy-epispadias repair. The detrusor bladder neck wrap appears to be a safe and effective adjunctive procedure in this patient population. We believe it has an important role in the achievement of urinary dryness.

Combined Injection and PPI Therapy for Bleeding Ulcers

Endoscopic injection therapy improves outcomes for patients with peptic ulcer bleeding and endoscopically documented stigmata. High-dose proton-pump

Comparison of hemostatic efficacy for epinephrine injection alone and injection combined with hemoclip therapy in treating high-risk bleeding ulcers

Rebleeding occurs in 10% to 30% of bleeding ulcer patients receiving endoscopic epinephrine injection therapy. It remains unclear whether addition of a secondary clip therapy following epinephrine injection may reduce the rebleeding rate of high-risk bleeding ulcers. To compare the efficacies of epinephrine injection alone and epinephrine injection combined with hemoclip therapy in treating high-risk bleeding ulcers. Prospective randomized controlled trial. A medical center in Taiwan. One hundred five bleeding ulcer patients with active spurting, oozing, nonbleeding visible vessels or adherent clots in ulcer bases. Endoscopic combination therapy (n = 52) or diluted epinephrine injection alone (n = 53). Initial hemostasis rates and recurrent bleeding rates. Initial hemostasis was achieved in 51 patients treated with combination therapy and 49 patients with epinephrine injection therapy (98% vs 92%, P = .18). Bleeding recurred in 2 patients in the combination therapy group and 11 patients in the epinephrine injection group (3.8% vs 21%, P = .008). Among the patients with rebleeding, repeated combination therapy was more effective than repeated injection therapy in achieving permanent hemostasis (100% vs 33%, P = .02). No patient required an emergency operation in the combination therapy group. However, 5 patients in the epinephrine injection group underwent emergency surgery to arrest bleeding (0% vs 9%, P = .023). Treatment outcome of endoscopic hemoclip therapy is related to the techniques of endoscopists. Endoscopic combination therapy is superior to epinephrine injection alone in the treatment of high-risk bleeding ulcers.