Gastroenterologia Japonica Copyright 9 1991 by The Japanese Society of Gastroenterology

Vol. 26, Suppl. 3 Printed in Japan

Variceal bleeding after endoscopic injection sclerotherapy: An analysis of 108 subjects undergoing endoscopic injection sclerotherapy M.A. F U J I N O , Y. Y A M A M O T O , H. T A C H I K A W A , T. N A K A M U R A , T. K A W A I , M. I K E D A , Y. M I Y A Z A K I , Y. A K A H A N E , and H. S U Z U K I

First Department o f Medicine, Yamanashi University School o f Medicine, Yamanashi, Japan

Introduction There were 95 upper GI bleeders admitted to our ward during the period from January 1984 through September 1989, including 52 cases of bleeding from variceal rupture (55% of total upper GI bleeders), 18 from gastric ulcer, 13 from duodenal ulcer, 5 from gastric carcinoma, 4 from endosco]~ic polypectomy site, 2 from leiomyosarcoma of the ileum and 1 from gastrointestinal invasion by carcinoma of the pancrease. Rupture of esophageal varices, therefore, was one of the major causes of upper GI bleeding. Endoscopic injection sclerotheray (EIS) has been performed widely to treat this condition. It is done also to prevent varicel bleeding, but the effect of EIS is not permanent. Post-EIS variceal bleeding is still a problem. This paper analyses the causes of post-EIS bleeding, in order to find the means of minimizing the risk of bleeding after EIS.

Materials and Methods During the period from January 1984 through September 1989 EIS was performed in 121 cases at our department. Excluding 13 drop-out cases, which were either lost to follow-up or submitted to surgery after EIS, 108 cases of EIS, in total, were the subjects of the study. Twenty-one cases underwent emergency EIS, 22 elective EIS, and 65 prophylactic EIS. Here, EIS performed with-

in 48 hours after variceal rupture is called emergency EIS. The indication for prophylactic EIS was impending variceal rupture as suggested by positive RC sign (small dilated vessels or microtelangiectasia on varix surface ~) on prominent varices. Intravariceal injection of 5% ethanolamine oleate according to Takase's method 2 was repeated until disappearance of injectible-sized varices, followed further by paravariceal injection of the same sclerosing agent for eradication of the smaller varices. The maximal volume of the intravaricelly injected sclerosant per session was 20 ml. Complete eradication of the varices was aimed at by repeated sessions. Emergency EIS was assessed as effective if there was no rebleeding for 1 month or longer after the procedure. In elective or prophylactic EIS the completeness was rated as follows: 1) Complete variceal eradication, if the varices completely disappeared, 2) markedly effective, if the varices have diminished to F 1 (small, straight varices 1) without RC sign, 3) moderately effective, if intermediate between markedly effective and ineffective, and 4) ineffective, if there has been no dimininution of varices. [(In the following discussion on completeness of EIS, cases of 1) and 2) cobined are designated as complete eradication and those of 3) and 4) combined as incomplete, for the sake of brevity.] The cases were followed up, if possible, up to March 1990; the period of follow-up ranged from 31 to 2039 days.

Gastlventerol Jpn 1991:26(Suppl3)27-31 Address for correspondence: Masayuki A. Fujino, M.D., First Department of Medicine, Yamanashi University School of Medicine, 1110 Shimokato, Tamaho, Nakakoma-gun, Yamanashi 409-38, Japan.

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M.A. Fujino et al.

Wilcoxon's test for cases without correspondence was used.

Elective v. Emergency EIS 100~ I

Results

80

~

70 l

I

1. Elective E I S v. emergency E1S

Elective EIS

50 lO

i ~176 z

30

~

~ L

2O 10 0

1000

Emergency EIS

1500

2000

2500

days

Fig. 1 Cumulative non-bleeding rates following elective and emergency EiS (Kaplan-Meier method). The elective EIS curve (22 cases) is significantly higher (P

Variceal bleeding after endoscopic injection sclerotherapy: an analysis of 108 subjects undergoing endoscopic injection sclerotherapy.

Among 108 cases of endoscopic injection sclerotherapy (EIS) performed from January 1984 through September 1989, post-EIS variceal bleeding occurred in...
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