Endoscopic Sclerotherapy Research Articles

Comparison of the effectiveness of 11 mainstay treatments for secondary prophylaxis of variceal bleeding in patients with cirrhosis: A network meta-analysis.

The purpose of the present study was to compare the effectiveness of the transjugular intrahepatic portosystemic shunt (TIPS), endoscopic options, medications and mainstay combination therapies for patients with cirrhosis who have had at least one episode of variceal haemorrhage. The PubMed, Embase, Cochrane Library and Web of Science databases, as well as the reference lists of relevant articles, were searched to identify eligible studies. P-scores, that were based solely on the point estimates and standard errors of the network estimates, were performed to rank all treatments, on a scale from 0 (worst) to 1 (best). The odds ratio (OR) was determined to assess effects on mortality, treatment failure and bleeding from gastroesophageal ulcers. A total of 43 randomized controlled trials comprising 3,787 adult patients were included. In total, 26 (61%) trials adopted concealed randomization, while most studies did not specify blinding. The drug combination of nadolol and isosorbide mononitrate (ISMN) ranked first for lowering risks of overall mortality (P-score=0.8162), mortality due to liver failure (P-score=0.7536) and bleeding from gastroesophageal ulcers (P-score=0.7536). This combination was determined to be superior to endoscopic sclerotherapy (ES) alone (OR=0.63, 95% CI: 0.42-0.94) and TIPS alone in reducing overall mortality (OR=0.62, 95% CI: 0.40-0.96). ES was more likely to increase treatment failure compared with TIPS, endoscopic variceal ligation (EVL), ES plus EVL, EVL plus nadolol/propranolol plus ISMN and nadolol/propranolol plus ISMN. In conclusion, the present network meta-analysis suggested that for a decreased mortality due to variceal rebleeding in patients with cirrhosis, nadolol plus ISMN may be a preferable choice, while ES is associated with a higher risk of unfavourable treatment outcomes. Further well-controlled studies are required to further elucidate the appropriate treatment options.

A182 LAST RESORT – RESOLVING REFRACTORY UPPER GI BLEEDS WITH ENDOSCOPIC APPLICATION OF FIBRIN GLUE

Abstract Background Endoscopic assessment of gastric bleeding is essential for timely investigation and evaluation in attempting to resolve bleeds. Increasingly, endotherapy is used to stop bleeds to prevent the patient from progressing to surgery. The tools available for the endoscopist can be broadly broke into injection sclerotherapy, mechanical tamponade, thermal methods and Hemospray©. Each method has their own inherent advantages and disadvantages with indications for use. Aims Unfortunately, patients fail despite standard endotherapy and would then be subjected to surgical procedures. Fibrin glue injection has been selectively described in case reports to resolve recalcitrant bleeds. We have reviewed endotherapy cases by one surgeon where fibrin glue was used to resolve recalcitrant upper gastrointestinal bleeding in a variety of clinical presentations. The goal was to show that endotherapy application of fibrin glue can be used to resolve challenging GI bleeds. Methods A retrospective review was made from one surgeon records of endoscopic bleed resolution with fibrin glue from 2010 to 2018. Indications for the procedure were gastric bleeds in hospital, emergency department, or undergoing endoscopic procedures that resulted in a heavy bleed. Patients were categorized as high risk using the Rockall score and those with known ulcers ertr graded as Forest Ia. The patients were of a variety of ages, sex, and had differing co-morbid medical conditions. The fibrin product used was Tisseel which is a two-component fibrin sealant and was deployed using a standard endoscopic Injection sclerotherapy needle. Results In all but one of the patients, hemostasis had been reached by delivering fibrin glue by endoscopy. The patient that failed treatment had multiple co-morbidities and the bleeding source was a gastric bed of venous malformations. Patients were followed up with next day scoping to confirm bleed hemostasis. No adverse reactions were noted. Conclusions Studies have shown in the past that fibrin glue has worked in achieving hemostasis and had a lower rate of re-bleeding. There are several advantages to using the biological process of the clotting system. The fibrin mat will stay localized and not spread into the lesion. Fibrin injection also creates the natural meshwork of normal biological healing. This naturally compress the mat meshwork along the wound and promote hemostasis. Fibrin glue can also be re-applied in the case of a site re-bleed. Treating endoscopically can beneficial in that patients may not need to progress to the risks and recovery times of surgery. Utilizing the biological process of the body allows for natural repair and degradation of the clot. The procedure is well tolerated and had showed no side effects in this review. Our findings support the use of fibrin glue injection endotherapy as a last resort before surgical intervention. Funding Agencies None

Prevalence and Clinical Significance of Portal Vein Thrombosis in Patients With Cirrhosis and Acute Decompensation

Portal vein thrombosis (PVT) is a common and serious complication in patients with cirrhosis. However, little is known about PVT in patients with cirrhosis and acute decompensation (AD). We investigated the prevalence and clinical significance of PVT in nonmalignant patients with cirrhosis and AD. We performed a retrospective study of 2 cohorts of patients with acute exacerbation of chronic liver disease who participated in the Chinese AcuTe on CHronic LIver FailurE study, established by the Chinese Chronic Liver Failure Consortium, from January 2015 through December 2016 (n= 2600 patients) and July 2018 through January 2019 (n= 1370 patients). We analyzed data on the prevalence, clinical manifestations, and risk factors of PVT from 2826 patients with cirrhosis, with and without AD. The prevalence of PVT in patients with cirrhosis and AD was 9.36%, which was significantly higher than in patients with cirrhosis without AD (5.24%) (P= .04). Among patients with cirrhosis and AD, 63.37% developed PVT recently (the first detected PVT with no indication of chronic PVT). Compared with patients without PVT, a significantly higher proportion of patients with PVT had variceal bleeding (47.33% vs 19.63%; P < .001) and patients with PVT had a significantly higher median serum level of D-dimer (2.07 vs 1.25; P < .001). Splenectomy and endoscopic sclerotherapy were independent risk factors for PVT in patients with cirrhosis and AD. The 1-year mortality rate did not differ significantly between patients with vs without PVT. In an analysis of data from 2826 patients with cirrhosis, a significantly higher proportion of those with AD had PVT than those without AD. PVT was associated with increased variceal bleeding, which would increase the risk for AD. Strategies are needed to prevent PVT in patients with cirrhosis, through regular screening, to reduce portal hypertension. ClinicalTrials.gov no: NCT02457637 and NCT03641872.

Comparative study of endoscopic band ligation versus injection sclerotherapy with 50% dextrose in water, in symptomatic internal haemorrhoids.

Haemorrhoids are common anorectal conditions seen in surgical practice, with various treatment modalities. This study compared the short-term outcome of injection sclerotherapy with 50% dextrose in water and rubber band ligation in the management of second-and third-degree haemorrhoids, in terms of symptoms improvement, complications, recurrence rate, retreatment rate and acceptability. This was a prospective comparative study that was carried out in the endoscopic unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, in southwestern Nigeria. Sixty consecutive patients with second- and third-degree haemorrhoids, who consented, were recruited into the study and were randomised into two groups. Group A had endoscopic injection sclerotherapy and Group B had endoscopic rubber band ligation. With regard to anal protrusion, more patients consistently reported either complete (16 [64.4%]) or partial (9 [40.9%]) resolution of symptoms in Group B, compared to Group A which had 7 (28.0%) and 5 (22.7%) cases, respectively (P = 0.03). Resolution of anal bleeding was initially more in Group B than A (22 [95.7%] vs. 17 [77.3%] patients, respectively), in the first 24-h post-treatment; however, within the 1st week, this ratio was reversed (P = 0.07). The retreatment rate for Group A and B was 23.3% and 13.3%, respectively,P = 0.34. More patients in Group B experienced severe pain post-treatment compared to Group A (P = 0.01). Three-month post-treatment, two (11.8%) patients in Group A and one (4.5%) in Group B had recurrence of anal bleeding (P = 0.42). There was no recurrence in anal protrusion in both treatment groups. Endoscopic rubber band ligation had a significantly higher success rate than endoscopic injection sclerotherapy, in terms of resolution of anal protrusion, but with higher pain score.

Prognosis of bleeding recurrence after endoscopic sclerotherapy of esophageal varices

To improve prediction of recurrent bleeding after endoscopic sclerotherapy of esophageal varices. A prospective, observational, case-control study was performed. Immediate and long-term results of endoscopic sclerotherapy of esophageal varices were studied in 91 patients for the period from 2002 to 2016. Multiple regression analysis with binary response model was applied to analyze the prediction models. Recurrent bleeding occurred in 80.5 (20; 182) days after sclerotherapy (range 0-2557 days). Spearman's correlation analysis revealed a significant relationship between bleeding recurrence and erythrocyte count (R= -0.32), Child-Pugh class of liver cirrhosis (R=0.49), Child-Pugh score (5-15) (R=0.54), content of amino acids, HPro/Pro ratio (R=0.71). Prognostic indicators were selected by stepwise inclusion of predictors. Thus, the final version of regression equation is as follows: Y=exp (-0.17+0.93×Child-Pugh score-106.42×HPro/Pro)/[1+exp(-0.17+0.93×Child-Pugh score-106.42×HPro/Pro)]. High risk of recurrent bleeding from esophageal varices within 1 year after endoscopic sclerotherapy is determined by Y-value >0.5. An accuracy of this model is 89.6%, Se 94.3%, Sp 79.2%, PPV 90.9%, NPV 86.4%, OR 63.3, LR + 4.53, LR - 0.07. Thus, the proposed method is highly informative, effective, available and can be widely used in clinical practice.

IMPROVEMENT OF EFFICIENCY OF PRIMARY HEMOSTASIS USING SENGSTAKEN - BLAKEMORE TUBE IN PATIENTS WITH PORTAL HYPERTENSION

Nowadays the efficient use of an obturator probe has remained not high enough, and is also accompanied with a number of particular complications. A study was performed to increase the effectiveness of primary hemostasis using the Sengstaken − Blackmore probe with a coating having hemostatic, antibacterial and regenerative properties in an acute episode of bleeding from varicose veins of the esophagus and stomach in the patients with liver cirrhosis and portal hypertension. A prospective, controlled, randomized study of the treatment results for the patients with an acute episode of bleeding from varicose veins of the esophagus and stomach on the background of liver cirrhosis complicated by portal hypertension was carried out. In the main group of patients, an ointment of a combined composition (antibacterial component, proline, oxidized cellulose) was preliminarily applied to the balloons of the obturator probe, which contributed to quite an effective hemostasis. In the patients using the standard methodology, the changes identified in laboratory and instrumental studies indicated unstable hemostasis. Thus, the use of an ointment of a combined composition to treat the balloons of the obturator probe prevents the damaging effect on a mucous membrane of the esophagus and accelerates its regeneration, prevents the aggravation of liver functional state by reducing the frequency of relapses and can be used as an independent method for treating the patients with bleeding from varicose veins of esophagus on the background of portal hypertension, and after performing an endoscopic sclerotherapy. Key words: portal hypertension, liver cirrhosis, bleeding, esophageal and gastric varices, proline, obturator probe.

Usefulness of endoscopic sclerotherapy with N-butyl-2-cyanoacrylate for perforating vein closure in esophageal varices

Usefulness of endoscopic sclerotherapy with N-butyl-2-cyanoacrylate for perforating vein closure in esophageal varices

Cap-assisted endoscopic sclerotherapy for internal hemorrhoids: technique protocol and study design for a multi-center randomized controlled trial.

Background:Cap-assisted endoscopic sclerotherapy is a new interventional therapy for internal hemorrhoids and rectal prolapse under colonoscopy. The proper length of the endoscopic injection needle is the core for performing cap-assisted endoscopic sclerotherapy well with more benefits and less complications. However, no data are currently available to guide endoscopists to consider the length of injection needle before cap-assisted endoscopic sclerotherapy. This study is designed to evaluate the efficacy and safety of cap-assisted endoscopic sclerotherapy with long or short injection needle in the treatment of internal hemorrhoids.Methods:This is a nationwide multi-center, prospective, single-blind and randomized controlled trial. Patients with grade I-II internal hemorrhoids who have failed to conservative treatments and grade III internal hemorrhoids who are not suitable for surgery or refuse surgery will be included. Participants will be randomized 1:1 into either long or short injection needle group. The primary outcome is the recurrence rate of internal hemorrhoids 24 weeks after cap-assisted endoscopic sclerotherapy. The secondary outcomes are as follows: (1) symptom severity score, (2) three-level EuroQoL five dimensions health scale scores, (3) occurrence of adverse events and severe adverse events, and (4) patients’ attitudes toward cap-assisted endoscopic sclerotherapy. Data collection will be conducted before and during operation, the 1st day, 1st week, 2nd week, and 24th week after cap-assisted endoscopic sclerotherapy.Discussion:The outcome of this study is expected to provide a practical clinical protocol of cap-assisted endoscopic sclerotherapy for patients with internal hemorrhoids and promote the use of this new endoscopic technique.Trial registration:ClinicalTrials.gov, NCT03917056. Registered on 12 April 2019.

Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid: An Effective and Less Invasive Strategy for Internal Hemorrhoids.

Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid: An Effective and Less Invasive Strategy for Internal Hemorrhoids.

2024 Novel Approach for Management of Stomal Variceal Bleed

INTRODUCTION: Patients with cirrhosis are prone to developing bleeding from varices. Patients with cirrhosis and ileostomy can develop ileostomy varices. Only 5% of variceal bleeds are reported to be from an ileostomy varix. CASE DESCRIPTION/METHODS: A 51-year-old female with heart failure, hepatitis C cirrhosis, esophageal varices with recent banding, colectomy with ileostomy presented with ostomy bleeding. Examination of the ostomy revealed oozing from the ostomy site. The ostomy site was cauterized with silver nitrate which initially stopped the bleeding. Esophagoduodenoscopy demonstrated three columns of non bleeding varices, no red whale/nipple sign and two non bleeding esophageal ulcers. Later, ostomy bleeding recurred which led to an ileoscopy. A non-bleeding ulcer was noted in the ileum. As the scope was withdrawn, an osteal varix was noted and due to the manipulation of the scope, the varix started squirting blood. Manual pressure was applied and a foley was inflated in the ostomy tract for tamponade. After 15 minutes of tamponade, the scope was re-inserted which did not demonstrate active bleeding. Banding couldn't be performed as there was no room to manipulate the scope. A CTA demonstrated two varices originating from the superior mesenteric vein within the ostomy track (Figure 1). TIPS was contraindicated due to heart failure. 2cc of Sotradecol was injected into each varix for obliteration via ultrasound guidance. After the injection, ultrasound showed successful obliteration of the varices (Figure 2). There was no further bleeding during her hospital stay. DISCUSSION: Ileostomy variceal bleeding is uncommon. Bleeding from an ileostomy varix can occur as early as a year after ileostomy placement in patients with cirrhosis. Diagnosis is often missed. It is key to inspect the stoma for bleeding after removal of the appliance. Doppler ultrasound or CT/MRI can aid in the diagnosis. There are multiple strategies to treat a variceal ostomy bleed including local control (ligation, sclerotherapy, intravascular coil or glue emboliziation) and portal vein decompression (TIPS). In majority of cases, local therapy is used as first line treatment as demonstrated in our patient who was successfully treated with sclerotherapy. We'd like to highlight the possibility of ultrasound guided sclerotherapy of osteal varices if endoscopic sclerotherapy is not feasible. More research is needed to assess which treatment strategy provides the best outcome for patients coming in with ileostomy variceal bleeding.

2026 Successful Hemostasis in Acute Gastric Variceal Hemorrhage With Hemospray (Hemostatic Powder)

INTRODUCTION: Currently there are few effective therapies for acute gastric variceal hemorrhage: endoscopic variceal ligation (EVL), cyanoacrylate injection, and endoscopic sclerotherapy (ESL). For variceal hemorrhage that is not amenable to these therapies, Transjugular intrahepatic portosystemic shunt (TIPS) or Balloon-occluded retrograde transvenous obliteration (BRTO) are recommended. For patients with contraindications to these procedures there is no effective treatment. Here we present a case of acute gastric variceal hemorrhage, in which hemostasis was successfully achieved with the use of Hemospray (hemostatic powder). CASE DESCRIPTION/METHODS: A 63-year-old hispanic man with PMH of HCV and alcoholic cirrhosis presented with coffee-ground emesis and melena. Admission vitals: T-37.7, HR-117, RR-20, BP-139/72, O2 sat-100% on RA. Physical exam was significant for only mild jaundice. Hemoglobin was 6.3. We started Protonix IV BID, Octreotide drip and Ceftriaxone QD. CT abdomen showed multiple metastatic appearing liver lesions, cirrhosis, varices, and cavernous transformation of the portal vein. Overnight his hemoglobin decreased to 4.5. During EGD, multiple gastric varices were noted including a large, actively hemorrhaging, GOV-2 varix. Unfortunately, we were unable to perform EVL due to the sheer volume of bleeding present. IR was consulted for emergent TIPS. However the patient was not a candidate for TIPS or BRTO due to the cavernous transformation of his portal vein. The decision was made to utilize Hemospray. EGD was repeated and the large GOV-2 gastric varix was seen actively hemorrhaging. A large, obstructing clot was removed and the site of bleeding was visualized. Hemospray was applied and hemostasis was quickly and effectively achieved. After application, the patient did not have recurrent bleeding. DISCUSSION: Hemostasis in the setting of acute gastric variceal hemorrhage can be very challenging to achieve. Hemospray should be considered when traditional therapies fail. It becomes cohesive and adhesive when it comes into contact with moisture, forming a stable mechanical barrier. Although there are few studies investigating its use in acute variceal hemorrhage, it was very effective in this case. Hemospray can also be useful for providing temporary hemostasis in an emergent situation; giving physicians more time to organize more definite treatments. Hemospray is a powerful endoscopic tool and should be considered when standard bleeding therapies are inadequate.

Exacerbation of Portal Hypertensive Enteropathy after Endoscopic Injection Sclerotherapy for Esophageal Varices

Introduction: Portal hypertensive enteropathy (PHE) is a well-known small-bowel lesion that occurs with liver cirrhosis (LC) and is associated with increased hepatic venous pressure. However, it is unclear how esophageal varices (EV) treatment actually affects PHE. We aimed to analyze the effects of EV treatment on PHE. Methods: Among LC patients who underwent capsule endoscopy (CE) more than twice to confirm PHE at our hospital from February 2009 to September 2018, we targeted those with no change in the Child-Pugh classification after EV treatment for the prevention of bleeding. Patients were assigned to groups based on the EV treatment method (endoscopic injection sclerotherapy [EIS] group or endoscopic variceal ligation [EVL] group). We analyzed the PHE findings before and after treatment, and we investigated changes in the collateral vein using computed tomography imaging. Results: We analyzed 42 LC patients (27 men; mean age, 65.3 years); 20 were in the EIS group and 22 were in the EVL group. Exacerbation of PHE was significantly prevalent in the EIS group (90%) compared to that in the EVL group (50%). CE of PHE showed significantly prevalent exacerbation of villous edema in the EIS group (65%) compared to that in the EVL group (23%). Stenosis or disappearance of the feeding vessel (55%) and exacerbation of the hepatofugal collateral vein (35%) were significantly prevalent in the EIS group. Conclusions: EIS exacerbates PHE, especially villous edema, in LC patients with changes in collateral circulation.

Endoscopic sclerotherapy under balloon-assisted enteroscopy for hemorrhagic jejunal varices after choledocho-jejunostomy.

Endoscopic sclerotherapy under balloon-assisted enteroscopy for hemorrhagic jejunal varices after choledocho-jejunostomy.

Effectiveness of Endoscopic Sclerotherapy with Aluminum Potassium Sulfate and Tannic Acid as a Non-Surgical Treatment for Internal Hemorrhoids.

Background/AimsSclerotherapy with aluminum potassium sulfate and tannic acid (ALTA) has a potent effect on internal hemorrhoids. In this retrospective study, we compared the effects of endoscopic ALTA therapy and standard ALTA therapy. MethodsWe investigated patients who underwent treatment for internal hemorrhoids at our institution between 2014 and 2016. They were divided into a standard ALTA group (n=33, treated using proctoscopy) and an endoscopic ALTA group (n=48). We compared the clinical findings between the 2 groups. ResultsThere were no intergroup differences in background factors. The mean ALTA dose was 21.9±7.2 mL and 17.8±3.4 mL in the standard and endoscopic ALTA groups, respectively (p<0.01). Adverse events occurred in 4 patients (12.1%) from the standard ALTA group and 6 patients (12.5%) from the endoscopic ALTA group. In both groups, the patients reported good satisfaction with the therapeutic effect at 1 month after the procedure. Hemorrhoids recurred in 2 patients (6.3%) from the standard ALTA group and 4 patients (8.3%) from the endoscopic ALTA group. ConclusionsEndoscopic ALTA sclerotherapy is equivalent to standard ALTA therapy in terms of efficacy, adverse events, and recurrence. Therefore, it is a useful non-surgical option for patients with internal hemorrhoids who prefer a less invasive treatment.

Duodenal Varices: A Rare Manifestation of Portal Hypertension

We report a case of haematemesis &amp; melaena due to ectopic varices located in the duodenum in a patient with NASH related CLD. Duodenal varices are a rare but potentially serious consequence of portal hypertension in the event of a bleeding. The etiology of duodenal varices can be classified into hepatic (e.g. cirrhosis) or extra hepatic (e.g. portal, splenic or superior mesenteric vein thrombosis). Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are widely accepted as primary therapies for esophageal variceal bleeding whereas bleeding gastric fundal varices are usually treated with cyanoacrylate injection or shunt procedures. However there is no widely accepted treatment modality for duodenal varices. In the case presented, we used injection sclerotherapy with ethanolamine oleate, to obliterate varices and control bleeding. A short review on the etiology pathogenesis and management of ectopic varices is presented.&#x0D; J Bangladesh Coll Phys Surg 2019; 37(3): 156-159

PF700 REAL‐WORLD DATA DEMONSTRATE SAFETY AND EFFECTIVENESS OF LUSUTROMBOPAG IN CHRONIC LIVER DISEASE PATIENTS WITH THROMBOCYTOPENIA UNDERGOING PLANNED INVASIVE PROCEDURES: INTERIM ANALYSIS

Background:Lusutrombopag is a thrombopoietin receptor agonist developed by Shionogi &amp; Co., Ltd. It is approved in Japan and US for improvement of thrombocytopenia, and in EU for patients with severe thrombocytopenia, associated with chronic liver disease scheduled to undergo invasive procedures. Postmarketing surveillance (October 2016‐May 2021) of safety and effectiveness data is ongoing in Japanese clinics.Aims:Data from 338 patients as of September 2018, including 21 re–treated patients, were analyzed for this interim report.Methods:Postmarketing surveillance plans to enroll 1,000 patients and follow them for 2 months after initial lusutrombopag dose. Patients receiving ≥1 re‐treatment within 6 months of initial treatment are observed for 2 months from start of each re‐treatment. This study captures data on adverse events occurring during and after treatment. Primary effectiveness outcome is proportion of patients who do not require pre‐operative platelet transfusion.Results:A total of 334 patients were evaluable for safety (4 excluded: registration violations [n = 2]; overlapping patients [n = 2]) and 318 for effectiveness (16 excluded: off‐label use [n = 1]; off‐indicated dosage/administration [n = 1]; use in unapproved population [Child‐Pugh C; n = 14]). Most patients had liver cirrhosis (315/334, 94%). Mean baseline platelet count ± SD was 46 ± 14x109/L (range 15–110; n = 315). There were 380 procedures in 334 patients, including 110/380 (28.9%) radiofrequency ablation, 59/380 (15.5%) transarterial chemoembolization, and 49/380 (12.9%) endoscopic injection sclerotherapy. Fourteen adverse drug reactions, including portal vein thrombosis (n = 4), increased alanine aminotransferase (n = 2), and increased aspartate aminotransferase (n = 2), were reported in 11/334 patients (3.3%). Forty‐one serious adverse events occurred in 29/334 patients (8.7%), including hepatic failure (n = 3; 0.9%), hepatic encephalopathy (n = 2; 0.6%), ascites (n = 2; 0.6%), and thrombosis (n = 1 splenic vein, 0.3%; n = 6 portal vein thrombosis, 1.8%); 7 events were considered treatment‐related. Mean time to procedure after starting lusutrombopag was 12.4 days. Two hundred eighty‐two (93%) of 303 patients without platelet transfusion refractoriness underwent procedure without platelet transfusion. After lusutrombopag, mean maximum platelet count was 89 ± 35x109/L (range 25–352; n = 288); mean maximum change from baseline platelet count was 42 ± 31x109/L (range −6–276; n = 288). In 21 re‐treated patients, no adverse drug reactions were reported during the observational period; platelet transfusion avoidance rate was 100%.Summary/Conclusion:Use of lusutrombopag in real‐world clinical practice demonstrates the product is safe and effective for patients with thrombocytopenia associated with chronic liver disease undergoing planned invasive procedures (consistent with previously reported clinical trial data).

Schistosomal portal hypertension: Randomized trial comparing endoscopic therapy alone or preceded by esophagogastric devascularization and splenectomy

Background. Upper gastrointestinal bleeding is a major cause of morbidity and mortality in patients with portal hypertension secondary to schistosomiasis mansoni.Aim. To evaluate the efficacy of combined surgery and sclerotherapy versus endoscopic treatment alone in the prophylaxis of esophageal variceal rebleeding due to portal hypertension in schistosomiasis.Material and methods. During a two-years period consecutive patients with schistosomiasis and a recent bleeding history were evaluated for prospective randomization. Absolute exclusion criteria were alcoholism or other liver diseases, whereas platelet count < 50,000/mm3, INR > 1.5 or presence of gastric varices were relative exclusion criteria. By random allocation 25 (group A) have received endoscopic sclerotherapy for esophageal varices alone and 22 (group B) combined treatment: esophagogastric devascularization with splenectomy followed by sclerotherapy. Interim analysis at 24 months has shown significant statistical differences between the groups and the randomization was halted.Results. Mean age was 38.9 ± 15.4 years and 58.46% were male. Mean follow-up was 38.6 ± 20.1 months. Endoscopic comparison of the size of esophageal varices before and after treatment did not show significant differences among the two groups. Treatment efficacy was assessed by the rate of recurrent esophageal variceal bleeding, that was more common in group A- 9/25 patients (36.0%) vs. 2/22 (9.0%) in group B (p = 0.029). Other complications were odynophagia, dysphagia and esophageal ulcer in group A and ascites and portal vein thrombosis in the surgical group.Conclusion. In portal hypertension due to schistosomiasis, combined surgical and endoscopic treatment was more effective for the prevention of recurrent esophageal variceal bleeding.

Cap-assisted Endoscopic Sclerotherapy for Internal Hemorrhoids and Rectal Prolapse

Cap-assisted Endoscopic Sclerotherapy for Internal Hemorrhoids and Rectal Prolapse

Інтенсивна терапія та малоінвазивні втручання в комплексному лікуванні крово-теч із варикозно розширених вен стравоходу у пацієнтів із декомпенсованим цирозом печінки

From January 2004 to December 2010 in the clinic of Transcarpathian Regional Clinical Hospital 64 patients with bleed-ing from esophageal varices with C-class liver cirrhosis by Child-Turcotte-Pugh criteria were examined and treated. The initial bleeding arrestin 39 (61%) patients was achieved with complex medical therapy and endoscopic sclerotherapy (ES). In 25 (39%) patients due to the inefficiency of the ES, authors used a Blakemore-Sengstaken tube. The III class of encephalopa-thy by West-Haven criteria was diagnosed in the in 37 (57.8%), in 27 it was of IV degree. In 3 (4.7%) patients ascites was transient and in 61 (95.3%) – refractory. In order to treat liver failure, as a major complication that caused bleeding adverse outcome in 27 patients with IV degree of encephalopathy authors used albuminperitoneal dialysis. Inorder to treat in-traabdominal hypertension at ascites in20 patients with III degree of hepatic encephalopathy authors applied laparocentesis with fluid evacuation. In17 patients they used extracorporeal ultrafiltration of asciticfluid with it’s subsequent intravenous reinfusion. In the subgroup of 39 patients with effective sclerotherapy the mortality rate was 23.1%. In the subgroup of 25 patients where the ES was ineffective and the Blackmore tube was applied, the mortality rate was 32%. Amongthe 20 pa-tients after laparocentesis with ascitic fluid evacuation 8 (40%) died. In the 17 patients after extracorporeal ultrafiltration of ascitic fluid with its subsequent intravenous reinfusion 2 (11.8%). In the subgroup where albumin peritoneal dialysis was applied 7 patients died (25.9%).A total of 17 (26.6%) patients died within the observation period of up to 5 days.

Does endoscopic sclerotherapy in filarial chyluria affect renal function and morphology? A prospective study using dimercaptosuccinic acid renal scan

ObjectiveTo look for change in relative renal function and document renal scarring following endoscopic renal pelvic instillation sclerotherapy (RPIS) in patients with chyluria by dimercaptosuccinic acid (DMSA) renal scan. MethodsA prospective study was performed between November 2015 and September 2016. All patients with biochemically documented chyluria who underwent RPIS using either 1%-silver nitrate or 0.1%-povidine iodine were included. Patients received either 3-, 6- or 9-doses. DMSA renal scan was performed before and 2–3 months after sclerotherapy. ResultsOf the 34 patients, 22 were males. Mean age was 41.08 ± 16.64 years (range, 15–70 years). Thirty-two patients (94.1%) responded to therapy while two did not respond even after 9-doses. Average follow-up was 8.94 ± 3.70 months. The mean relative renal function (pre-instillation) of normal kidney was 50.76% ± 3.55% while that of affected renal unit (side of instillation) was 49.20% ± 3.44% (range, 43.0%–61.0%). After instillation therapy, the mean relative renal function of normal side was 52.26% ± 3.57% while that of affected renal unit was 47.50% ± 3.56% (range, 41.0%–54.0%). The relative renal function did not change >5% from the baseline value in any patient except one (in which the differential function increased paradoxically by 12%). Two patients developed renal scar in post-instillation renal scan. ConclusionEndoscopic sclerotherapy in chyluria is safe and effective. The relative renal function does not deteriorate by more than 5%. There is a small risk of development of renal scar. More studies involving larger number of patients are needed to answer this dilemma.