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Hungting Chiang - One of the best experts on this subject based on the ideXlab platform.
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emergency banding ligation versus Sclerotherapy for the control of active bleeding from esophageal varices
Hepatology, 1997Co-Authors: Kwokhung Lai, Jinshiung Cheng, Chiunku Lin, Jershyung Huang, Pingi Hsu, Hungting ChiangAbstract:Active bleeding varices are a great challenge to endoscopists. In this study, we compared the short-term efficacy and safety of banding ligation with injection Sclerotherapy in the arresting of active bleeding from esophageal varices. Seventy-one cirrhotic patients with active variceal bleeding were randomized to receive banding ligation (37 patients) or Sclerotherapy (34 patients) immediately after endoscopic examinations. Primary success rate (bleeding stopped for 72 hours) was 97% in the ligation group and 76% in the Sclerotherapy group (P = .009). The efficacy of ligation was similar to Sclerotherapy in the control of oozing varices (100% vs. 89%, P = .23), whereas ligation was superior to Sclerotherapy in the control of spurting varices (94% vs. 62%, P = .012). The requirement of vasoconstrictors after emergency endoscopic treatment was lower in the ligation group than in the Sclerotherapy group (11% vs. 41%, P = .007). Treatment failure within 1 month was 8% in the ligation group vs. 30% in the Sclerotherapy group (P = .02). Blood transfusion requirements were significantly lower in the ligation group than in the Sclerotherapy group (3.2 +/- 1.2 vs. 4.5 +/- 1.8 units, P < .01). Rebleeding rate within 1 month was 17% in the ligation group and 33% in the Sclerotherapy group (P = .19). Significant complications were encountered in 5% of the ligation group and 29% of the Sclerotherapy group (P = .007). Mortality rates within 1 month were 19% in the ligation group and 35% in the Sclerotherapy group (P = .19). Banding ligation and Sclerotherapy were comparable in the arresting of oozing varices, whereas ligation was superior to Sclerotherapy in the control of spurting varices. Patients treated with ligation required fewer vasoconstrictors and fewer transfusion units than patients treated with Sclerotherapy. Furthermore, banding ligation was associated with a lower complication rate than Sclerotherapy.
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a prospective randomized trial of Sclerotherapy versus ligation in the management of bleeding esophageal varices
Hepatology, 1995Co-Authors: Kwokhung Lai, Jingshiung Cheng, Jiahuey Hwu, Chiafu Chang, Samming Chen, Hungting ChiangAbstract:We conducted a prospective, randomized trial comparing Sclerotherapy and ligation in 120 patients with acute bleeding of esophageal varices. All the patients were cirrhotic, 59 received Sclerotherapy, and 61 received ligation. Treatment was repeated regularly until the varices were obliterated. The mean follow-up period was 295 ± 120 days and 310 ± 105 days for the Sclerotherapy and ligation groups, respectively. The control of active bleeding was 12/15 (80%) in the Sclerotherapy group and 18/19 (94%) in the ligation group (P = .23). The numbers of treatment sessions required to achieve variceal obliteration were 6.5 ± 1.2 in the Sclerotherapy group and 3.8 ± 0.4 in the ligation group (P < .001). Recurrent bleeding from the gastrointestinal tract was 51% in the Sclerotherapy group compared with 33% in the ligation group (P < .05). Recurrent bleeding from esophageal varices was 36% in the Sclerotherapy group and 11% in the ligation group (P < .01). However, bleeding from ectopic varices and congestive gastropathy was less common in the Sclerotherapy group (7%) than in the ligation group (18%) (P = .05). Significant complications were encountered in 19% of the Sclerotherapy group and in 3.3% of the ligation group (P < .01). Comparison of KaplanMeier estimates of time to death of both groups showed a significantly lower mortality in the ligation group (P = .011). Both Sclerotherapy and ligation can effectively arrest active bleeding from esophageal varices. However, ligation is more effective than Sclerotherapy in decreasing the risk of rebleeding from esophageal varices with fewer complications. Ligation can also achieve obliteration of esophageal varices more rapidly than Sclerotherapy. Survival was significantly more improved after ligation than after Sclerotherapy. However, there was a greater incidence of bleeding from sites other than the esophageal varices after ligation.
Peter Bacchetti - One of the best experts on this subject based on the ideXlab platform.
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endoscopic Sclerotherapy compared with percutaneous transjugular intrahepatic portosystemic shunt after initial Sclerotherapy in patients with acute variceal hemorrhage a randomized controlled trial
Annals of Internal Medicine, 1997Co-Authors: John P Cello, Ernest J Ring, Eric W Olcott, Johannes Koch, Roy L Gordon, Jeet Sandhu, Douglas R Morgan, James W Ostroff, Don C Rockey, Peter BacchettiAbstract:Background: Hemorrhage from esophageal varices remains a substantial management problem. Endoscopic Sclerotherapy was preferred for more than a decade, but fluoroscopically placed intrahepatic portosystemic stents have recently been used with increasing frequency. Objective: To compare Sclerotherapy with transjugular intrahepatic portosystemic shunt (TIPS) in patients with bleeding from esophageal varices. Design: Randomized, controlled clinical trial. Setting: Three teaching hospitals. Patients: 49 adults hospitalized with acute variceal hemorrhage from November 1991 to December 1995: 25 assigned to Sclerotherapy and 24 assigned to TIPS. Intervention: Patients assigned to repeated Sclerotherapy had the procedure weekly. In those assigned to TIPS, an expandable mesh stent was fluoroscopically placed between an intrahepatic portal vein and an adjacent hepatic vein. Measurements: Pretreatment measures included demographic and laboratory data. Postrandomization data included index hospitalization survival, duration of follow-up, successful obliteration of varices, rebleeding from varices, number of variceal rebleeding events, total days of hospitalization for variceal bleeding, blood transfusion requirements after randomization, prevalence of encephalopathy, and total health care costs. Results: Mean follow-up (± SE) was 567 ± 104 days in the Sclerotherapy group and 575 ± 109 days in the TIPS group. Varices were obliterated more reliably by TIPS than by Sclerotherapy (P < 0.001). Patients having TIPS were significantly less likely to rebleed from esophageal varices than patients receiving Sclerotherapy (3 of 24 compared with 12 of 25; P = 0.012). No other follow-up measures differed significantly between groups. A trend toward improved survival, which was not statistically significant, was noted in the TIPS group (hazard ratio, 0.53 [95% Cl, 0.18 to 1.5]). Conclusions: In obliterating varices and reducing rebleeding events from esophageal varices, TIPS was more effective than Sclerotherapy. However, TIPS did not decrease morbidity after randomization or improve health care costs. It seemed to produce better survival, but the increase in survival was not statistically significant.
Sharon Simmons - One of the best experts on this subject based on the ideXlab platform.
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transjugular intrahepatic portosystemic shunts compared with endoscopic Sclerotherapy for the prevention of recurrent variceal hemorrhage a randomized controlled trial
Annals of Internal Medicine, 1997Co-Authors: Arun J Sanyal, Arthur M Freedman, Velimir A Luketic, Preston P Purdum, Mitchell L Shiffman, Patricia E Cole, J Tisnado, Sharon SimmonsAbstract:Background: Transjugular intrahepatic portosystemic shunts (TIPS) have widened the use of portal decompression as therapy for variceal hemorrhage. However, no controlled studies have examined the efficacy of TIPS compared with that of other treatments. Objective: To compare the efficacy and safety of TIPS with those of endoscopic Sclerotherapy for the prevention of recurrent variceal hemorrhage. Design: Randomized, controlled trial. Setting: Tertiary-care academic medical center. Patients: 100 patients with cirrhosis were evaluated a mean of approximately 10 days after an episode of acute variceal bleeding; 20 patients were excluded because of portal venous thrombosis (n = 6), hepatoma (n = 3), florid alcoholic hepatitis (n = 6), and refusal to give consent (n = 5). Interventions: TIPS (n = 41) or Sclerotherapy (n = 39). The latter was performed by freehand injections of 5% Na morrhuate at 2- to 3-week intervals. Recurrent variceal hemorrhage was managed by Sclerotherapy followed by angiographic assessment of TIPS and dilatation of the stents (TIPS group) or crossover to TIPS (Sclerotherapy group). Measurements: Rebleeding and survival were the primary end points. Complications and rates of rehospitalization were secondary end points. Results: During a mean follow-up of approximately 1000 days, recurrent gastrointestinal bleeding resulted from variceal hemorrhage (9 patients in the TIPS group and 8 in the Sclerotherapy group), portal gastropathy (1 patient in each group), and gastric lipoma (0 and 1 patients, respectively). A higher mortality rate was seen with TIPS (P = 0.03). Death resulted from variceal bleeding (5 patients in the TIPS group and 3 in the Sclerotherapy group), sepsis (3 and 2 patients, respectively), liver failure (2 patients in each group), hepatoma (1 and 0 patients, respectively), and hemoperitoneum (1 and 0 patients, respectively). Encephalopathy was the most common complication in the TIPS group (n = 12), and pain developing after Sclerotherapy was the most common in the Sclerotherapy group (n = 10). The two groups had similar rates of rehospitalization. Conclusions: Endoscopic Sclerotherapy and TIPS are equivalent with respect to rebleeding developing over the long term. However, Sclerotherapy may be superior to TIPS with respect to survival.
Kwokhung Lai - One of the best experts on this subject based on the ideXlab platform.
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emergency banding ligation versus Sclerotherapy for the control of active bleeding from esophageal varices
Hepatology, 1997Co-Authors: Kwokhung Lai, Jinshiung Cheng, Chiunku Lin, Jershyung Huang, Pingi Hsu, Hungting ChiangAbstract:Active bleeding varices are a great challenge to endoscopists. In this study, we compared the short-term efficacy and safety of banding ligation with injection Sclerotherapy in the arresting of active bleeding from esophageal varices. Seventy-one cirrhotic patients with active variceal bleeding were randomized to receive banding ligation (37 patients) or Sclerotherapy (34 patients) immediately after endoscopic examinations. Primary success rate (bleeding stopped for 72 hours) was 97% in the ligation group and 76% in the Sclerotherapy group (P = .009). The efficacy of ligation was similar to Sclerotherapy in the control of oozing varices (100% vs. 89%, P = .23), whereas ligation was superior to Sclerotherapy in the control of spurting varices (94% vs. 62%, P = .012). The requirement of vasoconstrictors after emergency endoscopic treatment was lower in the ligation group than in the Sclerotherapy group (11% vs. 41%, P = .007). Treatment failure within 1 month was 8% in the ligation group vs. 30% in the Sclerotherapy group (P = .02). Blood transfusion requirements were significantly lower in the ligation group than in the Sclerotherapy group (3.2 +/- 1.2 vs. 4.5 +/- 1.8 units, P < .01). Rebleeding rate within 1 month was 17% in the ligation group and 33% in the Sclerotherapy group (P = .19). Significant complications were encountered in 5% of the ligation group and 29% of the Sclerotherapy group (P = .007). Mortality rates within 1 month were 19% in the ligation group and 35% in the Sclerotherapy group (P = .19). Banding ligation and Sclerotherapy were comparable in the arresting of oozing varices, whereas ligation was superior to Sclerotherapy in the control of spurting varices. Patients treated with ligation required fewer vasoconstrictors and fewer transfusion units than patients treated with Sclerotherapy. Furthermore, banding ligation was associated with a lower complication rate than Sclerotherapy.
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a prospective randomized trial of Sclerotherapy versus ligation in the management of bleeding esophageal varices
Hepatology, 1995Co-Authors: Kwokhung Lai, Jingshiung Cheng, Jiahuey Hwu, Chiafu Chang, Samming Chen, Hungting ChiangAbstract:We conducted a prospective, randomized trial comparing Sclerotherapy and ligation in 120 patients with acute bleeding of esophageal varices. All the patients were cirrhotic, 59 received Sclerotherapy, and 61 received ligation. Treatment was repeated regularly until the varices were obliterated. The mean follow-up period was 295 ± 120 days and 310 ± 105 days for the Sclerotherapy and ligation groups, respectively. The control of active bleeding was 12/15 (80%) in the Sclerotherapy group and 18/19 (94%) in the ligation group (P = .23). The numbers of treatment sessions required to achieve variceal obliteration were 6.5 ± 1.2 in the Sclerotherapy group and 3.8 ± 0.4 in the ligation group (P < .001). Recurrent bleeding from the gastrointestinal tract was 51% in the Sclerotherapy group compared with 33% in the ligation group (P < .05). Recurrent bleeding from esophageal varices was 36% in the Sclerotherapy group and 11% in the ligation group (P < .01). However, bleeding from ectopic varices and congestive gastropathy was less common in the Sclerotherapy group (7%) than in the ligation group (18%) (P = .05). Significant complications were encountered in 19% of the Sclerotherapy group and in 3.3% of the ligation group (P < .01). Comparison of KaplanMeier estimates of time to death of both groups showed a significantly lower mortality in the ligation group (P = .011). Both Sclerotherapy and ligation can effectively arrest active bleeding from esophageal varices. However, ligation is more effective than Sclerotherapy in decreasing the risk of rebleeding from esophageal varices with fewer complications. Ligation can also achieve obliteration of esophageal varices more rapidly than Sclerotherapy. Survival was significantly more improved after ligation than after Sclerotherapy. However, there was a greater incidence of bleeding from sites other than the esophageal varices after ligation.
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Injection Sclerotherapy preceded by esophageal tamponade versus immediate Sclerotherapy in arresting active variceal bleeding: a prospective randomized trial.
Gastrointestinal Endoscopy, 1992Co-Authors: Kwokhung Lai, Tseng-nip Tam, Shou-dong Lee, Yang-te TsaiAbstract:To investigate whether Sengstaken-Blakemore tube tamponade is needed before emergency Sclerotherapy, 60 patients with active esophageal variceal bleeding were randomized to receive either immediate injection Sclerotherapy (group A) or Sclerotherapy preceded by balloon tamponade (group B). Three patients in group A (10%) were completely inaccessible to Sclerotherapy. Initial success in stopping bleeding at 24 hours after Sclerotherapy was 76% in group A and 81% in group B (p=0.89). Re-bleeding rate was 27% in group A versus 50% in group B (p=0.11). Blood requirement was significantly less in group A (3.7±2.5 units vs. 6.2±3.2 units, p
Arthur M Freedman - One of the best experts on this subject based on the ideXlab platform.
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transjugular intrahepatic portosystemic shunts compared with endoscopic Sclerotherapy for the prevention of recurrent variceal hemorrhage a randomized controlled trial
Annals of Internal Medicine, 1997Co-Authors: Arun J Sanyal, Arthur M Freedman, Velimir A Luketic, Preston P Purdum, Mitchell L Shiffman, Patricia E Cole, J Tisnado, Sharon SimmonsAbstract:Background: Transjugular intrahepatic portosystemic shunts (TIPS) have widened the use of portal decompression as therapy for variceal hemorrhage. However, no controlled studies have examined the efficacy of TIPS compared with that of other treatments. Objective: To compare the efficacy and safety of TIPS with those of endoscopic Sclerotherapy for the prevention of recurrent variceal hemorrhage. Design: Randomized, controlled trial. Setting: Tertiary-care academic medical center. Patients: 100 patients with cirrhosis were evaluated a mean of approximately 10 days after an episode of acute variceal bleeding; 20 patients were excluded because of portal venous thrombosis (n = 6), hepatoma (n = 3), florid alcoholic hepatitis (n = 6), and refusal to give consent (n = 5). Interventions: TIPS (n = 41) or Sclerotherapy (n = 39). The latter was performed by freehand injections of 5% Na morrhuate at 2- to 3-week intervals. Recurrent variceal hemorrhage was managed by Sclerotherapy followed by angiographic assessment of TIPS and dilatation of the stents (TIPS group) or crossover to TIPS (Sclerotherapy group). Measurements: Rebleeding and survival were the primary end points. Complications and rates of rehospitalization were secondary end points. Results: During a mean follow-up of approximately 1000 days, recurrent gastrointestinal bleeding resulted from variceal hemorrhage (9 patients in the TIPS group and 8 in the Sclerotherapy group), portal gastropathy (1 patient in each group), and gastric lipoma (0 and 1 patients, respectively). A higher mortality rate was seen with TIPS (P = 0.03). Death resulted from variceal bleeding (5 patients in the TIPS group and 3 in the Sclerotherapy group), sepsis (3 and 2 patients, respectively), liver failure (2 patients in each group), hepatoma (1 and 0 patients, respectively), and hemoperitoneum (1 and 0 patients, respectively). Encephalopathy was the most common complication in the TIPS group (n = 12), and pain developing after Sclerotherapy was the most common in the Sclerotherapy group (n = 10). The two groups had similar rates of rehospitalization. Conclusions: Endoscopic Sclerotherapy and TIPS are equivalent with respect to rebleeding developing over the long term. However, Sclerotherapy may be superior to TIPS with respect to survival.
