Sclerotherapy Agents Research Articles

Value of endoscopy application in the management of complications after radical gastrectomy for gastric cancer

Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.

Neuropathy after sodium tetradecyl sulfate sclerotherapy of venous malformations in children.

To estimate the risk of nerve injuries and assess outcomes after sodium tetradecyl sulfate (STS) sclerotherapy of venous malformations (VMs) in children. Sclerotherapy is the treatment of choice for most VMs, but all sclerotherapy agents are associated with the risk of complications. Neuropathy is considered a rare but potentially serious complication of venous sclerotherapy. The institutional review board waived ethical approval for this retrospective review, in which 647 sclerotherapy procedures were performed in 204 patients (104 female and 100 male patients; mean age, 9 years 6 months [range, 6 months to 17 years 11 months]) as treatment for symptomatic VMs. Technical and clinical success of the treatment was evaluated. Complications were reviewed with a particular focus on nerve injury. Informed consent, specifying the risk of neuropathy, as well as pain, swelling, infection, risks of anesthesia, skin injury, nonresolution or worsening of symptoms, and possible need for further or multiple procedures, was obtained for all patients. Standard sclerotherapy techniques were used. Technical details of all procedures were recorded prospectively. Follow-up included immediate postprocedural assessment and outpatient clinic review. All nerve injuries were recorded. Patients were monitored and treated according to clinical need. Confidence intervals were calculated by using the Wilson method, without correction for continuity. Treatment was technically successful in 197 of 204 patients (96.6%), and clinical success was achieved in 174 of 204 (85.3%). Thirty-seven of the 647 procedures (5.7%) resulted in a complication, including 11 cases of excessive swelling, nine cases of skin injury, two patients with infection, and two with pain. Motor and/or sensory nerve injuries occurred after seven procedures (1.1%). Five of the seven children had undergone at least one previous sclerotherapy procedure. Neuropathy resolved spontaneously in four patients and partially recovered in three, of whom two underwent surgery. Surgery included debridement of necrotic tissue, carpal tunnel decompression, and external neurolysis. Nerve injury is an unusual but not rare complication of STS sclerotherapy. A degree of recovery, which may be complete, can be expected in most patients.

OK432 Versus Doxycycline for Treatment of Macrocystic Lymphatic Malformations

A variety of sclerotherapy agents are used to treat macrocystic lymphatic malformations (LMs). This retrospective study at a single institution was performed to compare the outcomes of pediatric macrocystic LMs of the head and neck that were treated with doxycycline or with OK432. The outcomes measured included early response to therapy, number of treatments required, operating room time, and adverse events. The rates of clinical success for OK432 and doxycycline were similar (83% and 82%, respectively; p > 0.05), although OK432-treated patients required more treatments than did doxycycline-treated patients (1.9 versus 1.0 injections; p = 0.01; 95% confidence interval, 1.57 to 0.27). The average operating room time for a single OK432 injection was significantly shorter than that for doxycycline (53.2 versus 98.1 minutes; p < 0.001); however, when the total number of treatments administered was considered, the overall times in the operating room were similar. Adverse events in the early postoperative period were more common in OK432-treated patients, who experienced marked postoperative swelling compared to doxycycline-treated patients. OK432 and doxycycline are both effective sclerosants for the treatment of predominantly macrocystic LMs. The administration time for OK432 is shorter than that for doxycycline, but OK432 required more treatments overall to achieve clinical success. Early adverse events were more common in OK432-treated patients, but longer follow-up is necessary to determine whether rates of recurrence and adverse events are similar, particularly in light of the risk of tooth discoloration in doxycycline-treated patients.

Long-term results of pleurodesis in malignant pleural effusions: Doxycycline vs Bleomycin.

Background:The aim of this study was to compare the response of doxycycline and bleomycin in pleurodesis of malignant pleural effusions.Materials and Methods:The radiologic and clinical responses of doxycycline and bleomycin in pleurodesis of malignant pleural effusions were compared in this randomized clinical trial. Forty-two patients were randomized to receive either bleomycin 45 mg or doxycycline 600 mg as the sclerotherapy agent. Chest X-rays were taken before and after intervention, 10 days and 2 months later to compare the radiologic response. Dyspnea and other side effects, before and after intervention, 10 days and 2 months later were recorded and compared. Chi-square test was applied to analyze the data.Results:The prevalence of dyspnea and its different severities, 10 days and 2 months after intervention were significantly different (P < 0.05) between the two groups. Analysis of pleural effusions revealed a significant difference (P < 0.05) between Doxycycline vs. Bleomycin 2 months after the intervention. Three months after pleurodesis, only one patient in bleomycin group needed pleural fluid drainage.Conclusion:Pleural effusions did not change with use of doxycycline and bleomycin in short time but long-term results of doxycycline sclerotherapy was better than bleomycin sclerotherapy in malignant pleural effusions that was supported by this study. However, additional studies with larger sample size are necessary to confirm the results.

Sclerotherapy for Intra-abdominal Lymphatic Malformations in Children

Sclerotherapy is well described as a treatment for lymphatic malformations (LMs) in the head, neck, and other soft tissue areas. This study aims to evaluate the effectiveness of intralesional sclerotherapy as primary treatment for intra-abdominal LMs in children. We conducted a retrospective review from 2008 to 2012 of all children with intra-abdominal LMs treated with sclerotherapy at our tertiary children's hospital. In this study, five patients underwent sclerotherapy as a primary intervention for intra-abdominal LMs. The ages of these patients ranged from 12 to 52 months at the time of initial treatment. Doxycycline was used as the primary sclerotherapy agent. The patients required between three and five (median 3) sclerosing treatments over a period that ranged from 5 to 366 days (median 28). No child has required an operation and all LMs have decreased in size. The median decease in maximum diameter is 62% (21-67). Complete resolution has not been attained but all have experienced symptomatic relief with a median follow-up of 3 (1-24) months. Sclerotherapy is an effective first-line therapy for intra-abdominal LMs in the pediatric population and should be considered when treating these difficult lesions.

3:38 PM Abstract No. 162 - A test of nerves. The incidence of neuropathy following sts sclerotherapy of venous malformations

Purpose Sclerotherapy is widely advocated as the treatment of choice for venous malformations (VMs). Several sclerotherapy agents are available and a range of risk factors are associated with their use. There are almost no examples of neuropathy resulting from sodium tetradecyl sulfate (STS) published in the literature. We report our experience of neuropathy as a complication of STS sclerotherapy. Materials and Methods All VM sclerotherapy procedures performed between 1999-2012 were reviewed. Standard technique was used with STS as foam, formed from a 1:1:2 mixture of iohexol contrast, air and 3% STS. At the time of treatment technical details were recorded for all procedures including needle size and insertion technique, number, location and classification of treated lesions, the volume and nature of sclerosant used and whether steroids or antibiotics were given. All nerve lesions were recorded. Routine follow-up included post-operative assessment, post discharge telephone call and outpatient clinic appointments. Results 847 procedures were performed. Motor and/or sensory nerve lesions occurred after 10 (1.2%) of 847 procedures. 7 of the 10 cases were in patients that had undergone at least 1 previous sclerotherapy procedure. Neuropathy was seen following treatment of 5 Puig type II lesions, 5 type III and a single type I lesion. Nerve lesions were managed according to clinical need including surgical consultant with a peripheral nerve specialist, physiotherapy and nerve conduction studies. Neuropathy improved in all cases with complete resolution in 7 and partial resolution in 3 patients of whom two required surgery. Conclusion Nerve injury is a rare complication of STS sclerotherapy and an important factor to consider when deciding to treat VMs. A degree of recovery was seen in most patients, but may be incomplete. The literature to date doesn't report neuropathy with STS but our series demonstrates that nerve injury can occur. We advocate active management of neuropathy with physiotherapy, nerve conduction studies and surgical consultation. Long-term follow up is recommended. The authors advocate sharing of clinical information of sclerotherapy complications, to enable prevention, appropriate management and prognostication of lesions.

Doxycycline sclerotherapy for pediatric head and neck macrocystic lymphatic malformations: A case series and review of the literature

Objective(a) To evaluate the efficacy of doxycycline as a percutaneous sclerotherapy agent in pediatric head and neck macrocystic lymphatic malformations (LM) and (b) to review the literature with regard to recent developments in the treatment of lymphatic malformations using sclerotherapy. MethodsWe reviewed the medical records and imaging studies of all patients who underwent percutaneous sclerotherapy of macrocystic LM of the head and neck at our institution between June 2005 and May 2010. All studies were reviewed and procedures performed by a single interventional neuroradiologist using computed tomography (CT) guidance. LM were individually cannulated, the contents aspirated, and then injected with doxycycline at concentrations of 10–20mg/ml. Response to sclerotherapy was determined clinically. ResultsSeven patients underwent a total of eight sclerotherapy treatments during the study period. Of the six patients with appropriate follow-up, 67% have experienced complete or near-complete clinical resolution of their LM (1243 days mean follow-up), while 33% have developed recurrent swelling after an initial response following a single doxycycline injection (53 days mean follow-up). ConclusionsOur institutional results, in combination with recently published findings, support the moderate efficacy and excellent safety profile of percutaneous doxycycline sclerotherapy for macrocystic lymphatic malformations.

Sklerotherapie bei Erkrankungen im HNO-Bereich

Cystic lesions are frequently occurring diseases of the head and neck region. Complete surgical resection near to neurovascular structures can be accompanied by various complications. In selected cases intralesional injection of OK-432 could constitute an alternative. The average success rate of sclerotherapy of lymphatic malformations is 60%. Side effects are rare. Sclerotherapy is a minimally invasive, simple and cost-effective procedure performed without general anaesthesia at the outpatient clinic. Nerve lesions or troublesome scarring do not occur. In residual cases surgical excision is realisable without any difficulty. Repeated injections of sclerotherapy agents represent a disadvantage. Abscess formation has been observed as a rare complication. A malignant disease has to be excluded by cytological examination before commencing sclerotherapy. The intracystic injection of OK-432 is an effective treatment modality for cystic cervical lesions.

Injection snoreplasty: investigation of alternative sclerotherapy agents

Objective Palatal sclerotherapy with sodium tetradecyl sulfate (“injection snoreplasty”) was recently introduced as a safe and effective treatment for primary snoring. However, multiple other sclerotherapy agents also have excellent safety records and documented efficacy in the head and neck. Widely available and inexpensive agents were evaluated as potential palatal sclerosing agents for the treatment of snoring. Study design and setting A described canine palatal flutter model was used to evaluate the palatal stiffening efficacy of ethanol, doxycycline, and hypertonic saline in comparison to 3% sodium tetradecyl sulfate (STS) and a negative control (normal saline). Based on the animal study results, a human pilot study with ethanol was performed with subjective and objective data. Results Ethanol was found to be equally effective as 3% STS in the canine model. Doxycycline was effective but less so, and hypertonic saline was comparatively ineffective. Palatal injection in human patients with 50% ethanol was found to produce equivalent subjective and objective snoring efficacy and equivalent pain and recovery time compared with 3% STS. However, there was a higher rate of transient palatal fistula with ethanol. Conclusions and significance Injection snoreplasty with 50% ethanol is equally efficacious compared with 3% STS. There could be a higher fistula rate with the use of ethanol, although this complication has been self-limited and transient in every case.

Injection snoreplasty

Soft palate sclerotherapy (“injection snoreplasty”) is a popular technique as a primary treatment of palatal snoring because of its comparative advantages over other snoring procedures. It is very simple to perform during a routine office visit, is minimally painful, is highly effective, and is very inexpensive. After topical anesthesia, the midline soft palate is injected submucosally with a small amount of sodium tetradecyl sulfate—a well-described, safe sclerotherapy agent. Controlled fibrosis eliminates or significantly diminishes palatal flutter snoring. The technique with “How I Do It” pearls is described in this article. Soft palate sclerotherapy (“injection snoreplasty”) is a popular technique as a primary treatment of palatal snoring because of its comparative advantages over other snoring procedures. It is very simple to perform during a routine office visit, is minimally painful, is highly effective, and is very inexpensive. After topical anesthesia, the midline soft palate is injected submucosally with a small amount of sodium tetradecyl sulfate—a well-described, safe sclerotherapy agent. Controlled fibrosis eliminates or significantly diminishes palatal flutter snoring. The technique with “How I Do It” pearls is described in this article.

OK-432 (Picibanil) therapy for lymphangiomas in children.

Lymphangiomas are benign, soft tumors that most often affect the head and neck area, usually causing marked cosmetic and functional problems. Treatment options include surgery and a large number of different sclerotherapy agents. Surgical treatment is challenging because of the need for complete excision. The risk of damage to surrounding structures or poor cosmetic results is high. Various sclerotherapy agents have been shown to have minimal effects on lymphangiomas. Their use has been associated with severe systemic, local and cosmetic side effects. OK-432 (Picibanil) is a new and promising form of sclerotherapy. An intracystic injection of OK-432 produces a local inflammatory reaction, which leads to resolution of the lesion. We have treated 11 pediatric lymphangioma patients with OK-432 with excellent results: complete regression in six, marked regression in four and no response in one case. Local swelling should be anticipated, especially when treating lesions near the upper airway. We found OK-432 injections to be safe and effective as a first line of treatment for lymphangiomas.

Injection snoreplasty: How to treat snoring without all the pain and expense

Objective: We introduce Injection Snoreplasty: an innovative, safe, and effective palatal snoring procedure with minimal cost and discomfort to the patient. A well-described sclerotherapy agent, Sotradecol, is injected into the soft palate to reduce/eliminate palatal flutter snoring. Study Design and Setting: Twenty-seven patients with a diagnosis of palatal flutter snoring (respiratory disturbance index less than 10) by sleep study were enrolled in the protocol. Office treatment sessions were performed 6 to 8 weeks apart. Success was judged by subjective improvement in snoring and objective evidence of palatal stiffening/scarring. Results: Twenty-five (92%) of 27 patients reported significant decrease in snoring. There were no significant postinjection complications. Visual analog pain scale confirmed minimal discomfort. Most patients received more than 1 treatment (average, 1.8) in order to receive optimal palatal stiffening. Conclusion/Significance: Injection Snoreplasty is a simple, safe, and effective office treatment for primary snoring. Advantages over current snoring procedures include simplicity, low cost, decreased posttreatment pain levels, and minimal/no convalescence. (Otolaryngol Head Neck Surg 2001;124:503-10.)

Endoscopic sclerotherapy with fibrin glue as compared with polidocanol to prevent early esophageal variceal rebleeding

Background/Aims: Endoscopic sclerotherapy is of proven benefit for patients after esophageal variceal bleeding, but is associated with substantial local and systemic complications. Since fibrin glue is a promising agent for endoscopic schlerotherapy of esophageal varices, we compared its safety and efficacy in patients after esophageal variceal bleeding. Patients and Methods: In a randomized, controlled trial, 36 patients with an acute episode on variceal bleeding were endoscopically treated with either polidocanol (18 patients) or fibrin glue (18 patients) by intravariceal injections within 12 h of admission. Tissue compatability, incidence of various complications, episodes of rebleeding and overall survival rates were investigated. Results: Rebleeding, especially from enrollment to day 28, was less common in the fibrin group ( p=0.046), and all patients treated with fibrin glue survived for more than 28 days, whereas five patients treated with polidocanol died within this period. The incidence of sclerotherapy-induced ulcers was significantly lower in the fibrin group than in the polidocanol group ( p=0.001), and major complications such as perforation or ulcer bleeding were observed only in the polidocanol group. There were no complications in any group due to activation of systemic coagulation, fibrinolysis or clinically relavant pulmonary embolization. Conclusions: We conclude that fibrin glue is an efficient and safe agent for endoscopic sclerotherapy of bleeding esophageal varices, especially in the immediate posthemorrhagic period.

How does change in concentration of esophageal variceal sclerotherapy agents impact on patient outcome?

How does change in concentration of esophageal variceal sclerotherapy agents impact on patient outcome?

Sclerotherapy With Alcohol-A Two–Edged Sword!

Absolute alcohol is a potentially optimal agent for sclerotherapy of esophageal varices. It is cheap and readily available. We compared the efficacy and safety of alcohol with those of a commonly used sclerosing agent, polidocanol. The study was planned to include patients with previous bleeding from esophageal varices randomly assigned to one of the two treatments. After the inclusion of the first 11 patients (6 in the polidocanol group and 5 in the alcohol group), however, the trial was interrupted because of serious complications in patients treated with alcohol (four major bleeding episodes and one esophageal stenosis). The two agents were of comparable efficacy in the small sample of patients studied. The complications were related to the presence of iatrogenic esophageal ulcers which were more frequent (100% vs 30%) and significantly larger (mean, 1.4 cm vs 0.7 cm, p &lt; 0.05) in patients treated with alcohol.

Taking the Tension out of the Portal System: An Approach to the Management of Portal Hypertension in the 1990s

The past decade saw the emergence of sclerotherapy and vasoactive pharmacologic agents as alternatives to surgery in the prevention and treatment of variceal haemorrhage. Despite encouraging results from clinical trials with regard to the prevention of rebleeding, these modalities of therapy have made no major impact on survival. This failure to alter radically the clinical outcome results from the fact that in many patients with cirrhosis death is primarily related to the degree of hepatic decompensation rather than the prevention or control of variceal bleeding. Advances in our knowledge of vasoactive mediators, receptor function, and altered vascular reactivity have provided increased insight into the circulatory disturbances that characterise cirrhosis and portal hypertension. Earlier and more aggressive pharmacologic intervention with single or combination drug therapy may inhibit fibrogenesis, reduce portal vascular resistance, and improve liver function and therefore provide effective prophylaxis against variceal haemorrhage. The emergence of reliable prognostic indices for variceal bleeding should help identify patients at risk who would benefit from prophylaxis with either drugs or sclerotherapy. Transplantation will be increasingly considered in the patient at high risk of recurrent bleeding before the stage of severe hepatic decompensation (the risks of the transplant then become very much greater), as the definitive means for reducing mortality in cirrhosis and portal hypertension.

Absolute alcohol in esophageal vein sclerosis

Absolute alcohol is a potentially optimal agent for sclerotherapy of esophageal varices. It is cheap and readily available. We compared the efficacy and safety of alcohol with those of a commonly used sclerosing agent, polidocanol. The study was planned to include patients with previous bleeding from esophageal varices randomly assigned to one of the two treatments. After the inclusion of the first 11 patients (6 in the polidocanol group and 5 in the alcohol group), however, the trial was interrupted because of serious complications in patients treated with alcohol (four major bleeding episodes and one esophageal stenosis). The two agents were of comparable efficacy in the small sample of patients studied. The complications were related to the presence of iatrogenic esophageal ulcers which were more frequent (100% vs. 30%) and significantly larger (mean, 1.4 cm vs. 0.7 cm, p less than 0.05) in patients treated with alcohol.

イオパミドールを配合したオレイン酸エタノールアミン注射液の調整

Ethanolamine oleate injection containing 30% iopamiron 300 (30% IP 300-E0) has been previously prepared for endoscopic sclerotherapy of esophageal varices on X-ray TV monitor. However, the ability of fluoroscopic visualization of this sclerosing agent was slightly insufficient in clinical use.We prepared ethanolamine oleate injection containing 30% iopamiron 370 (30% IP 370-E0), and measured the physical characteristics such as viscosity and osmotic pressure of this agent.The ability of visualization was observed in patients with esophageal varix by X-ray.The viscosity, which was inversely related to the injectability into varices, of 30% IP 370-E0 was relatively low and its osmotic nressure was almost the same as that of normal saline.30% IP 370-E0 was easily injected into varices.Better fluoroscopic visualization was obtained by intravariceal injection with 30% IP 370-E0 than with 30% IP 300-E0.These results suggest that 30% 1P370-E0 is more useful agent for endoscopic sclerotherapy of esophageal varices.

Stability of Agent for Injection Sclerotherapy (Endoscopic Embolization) for Esophageal Varix

As an agent for injection sclerotherapy (endoscopic embolization) for esophageal varix, an injectable solution (EOMA) was prepared by mixing ethanolamine oleate injection (EO) with meglumine amidotrizoate injection. For the stability evaluation of EOMA and EO, tests were performed with the samples prepared under 4 different conditions to observe changes in appearance with time, pH, oleic acid content, iodine value, benzyl alcohol content and amidotrizoic acid content for 8 weeks.No abnormality was observed in appearance of all the samples of EOMA and EO, except slight development of a brown color in sterilized samples of both injections. Almost no change was observed in pH of both EOMA and EO during the 8-week test period. The pH of EOMA was lower than that of EO, since EOMA contained meglumine amidotrizoate injection of pH of about 6.5. No major change was observed in oleic acid contents and iodine values of both EOMA. and EO during the test period, nor was seen any difference in those values amongsamples prepared under different conditions, and benzyl alcohol also showed simila r results. Also amidotrizoic acid mixed in EOMA showed almost no change throughout the 8 weeks.These results suggest that both EOMA and EO, prepared in any condition, are stable for 8 weeks, if they are preserved in a dark and cold place.