Endoscopic injection sclerotherapy improves liver function compared with endoscopic variceal ligation

Liver function is a most important prognostic factor in patients with liver cirrhosis. Also, portal hypertension is a fatal complication of liver cirrhosis and variceal treatment is indispensable. However, changes of liver functions after endoscopic variceal treatments are unknown. The aim of this study was to evaluate prognosis and liver functions after endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). A total of liver cirrhotic 103 patients who underwent prophylactic EIS and EVL were enrolled. Overall survival rate was higher in EIS group than EVL group (p = 0.03). Multivariate analysis showed that EIS was a negative factor for death (HR: 0.46, 95% confidence interval: 0.24–0.88, p = 0.02). Liver functions were assessed by blood test taken at before and 3 months after treatment. In EIS group, albumin and prothrombin time improved (p < 0.01), leading to improvement of Child–Pugh score, ALBI score and MELD score (p < 0.05). However, these did not improve in EVL group. EIS was a significant factor related to the elevated value of albumin after treatment in linear regression analysis (estimated regression coefficient: 0.17, 95% confidence interval: 0.05–0.29, p = 0.005). These results revealed that EIS could improve liver functions and prognosis.

Endoscopic Injection Sclerotherapy Improves Liver Function Compared with Endoscopic Variceal Ligation

Liver function is a most important prognostic factor in patients with liver cirrhosis. Also, portal hypertension is a fatal complication of liver cirrhosis and variceal treatment is indispensable. However, changes of liver functions after endoscopic variceal treatments are still unknown. The aim of this study was to evaluate liver functions after endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). A total of liver cirrhotic 103 patients who underwent prophylactic EIS and EVL were enrolled. Liver functions were assessed by blood test taken at before and 3 months after EIS and EVL. In EIS group, albumin and prothrombin time improved significantly (p < 0.01), which led to improvement of Child-Pugh score, ALBI score and MELD score (p < 0.05). However, these factors did not improve in EVL group. Overall survival (OS) rate was significantly higher in EIS group than EVL group. Subsequently, in EIS group patients who improved albumin showed significantly better OS than those who did not improved. In multivariate analysis, improvement of albumin at 3 months after EIS was associated with better prognosis (HR: 0.38, 95% confidence interval: 0.19- 0.77, p = 0.007). These results revealed that EIS could improve liver functions and prognosis.

Novel Endoscopic Therapy for Gastric Varices Using Direct Forward-Viewing Endoscopic Ultrasonography

Gastric varices (GV) carry a high risk of massive hemorrhage because of potential rupture. To reduce the risk associated with GV, patients need to undergo hemostatic and preventive treatment. The objective of this retrospective study was to evaluate the usefulness of a new method, direct forward-viewing endoscopic ultrasonography (DFV-EUS) for the treatment of GV. We performed endoscopic injection sclerotherapy with histoacryl (EIS-HA) using DFV-EUS for GV in four patients. The paracentesis success rate was 75% (3/4). DFV-EUS has a significant advantage for the treatment of GV in that it can show physicians endoscopic and ultrasound views in real time during the delivery of the sclerosant into the GV. However, the proper use of the ultrasound view must be elucidated through further research for safer and more effective therapy. In the presence of distance between the mucosal surface and vascular lumen or when the blood flow site requires puncture as an additional treatment, DFV-EUS might be a good candidate for the treatment of GV. Altogether, EIS-HA with DFV-EUS might be a new therapeutic option for patients with GV.

Retrograde Endoscopic Sclerotherapy for Management of Internal Haemorrhoids

BACKGROUND Haemorrhoids are one of the most common anorectal conditions encountered in clinical practice and are recognised as a common cause of rectal bleeding, perianal itching and anal discomfort. Therapeutic treatment of haemorrhoids needs to be tailored according to grades and complication of haemorrhoids, patient preference and expertise of procedure. Very limited data is available regarding effectiveness of retrograde endoscopic injection sclerotherapy for the management of bleeding haemorrhoids. We wanted to study the effectiveness of retrograde endoscopic sclerotherapy (REST) for the management of various grades of bleeding internal haemorrhoids. METHODS A prospective study, included 87 patients with Gr. I, II and Gr. III symptomatic bleeding internal haemorrhoids. They were subjected to retrograde endoscopic sclerotherapy using Inj. Polidocanol to study its effectiveness in controlling bleeding. Effectiveness of the procedure was defined by stoppage of bleeding at 3 months follow up. RESULTS Bleeding stopped in 95.3 % cases after retrograde endoscopic sclerotherapy at 3 months follow up. No significant complications were observed with the procedure during the study period. CONCLUSIONS Retrograde endoscopic sclerotherapy is a safe, well tolerated and effective modality for the management of bleeding internal haemorrhoids. KEYWORDS Haemorrhoids, Retrograde Endoscopic Sclerotherapy