Abstract
Injection sclerotherapy of esophageal varices has become the standard therapy for patients bleeding from these lesions. Studies have shown this technique to be superior to other nonsurgical therapies and to selective shunt surgery in terms of survival and quality of life. The efficacy of this therapy, though, has been reduced by sclerotherapy-induced ulcerations. Tissue necrosis from the necrotizing chemical injected to sclerose the varices may result in deep ulceration with both arterial and venous bleeding, occasionally with perforation of the esophagus. Sucralfate has been suggested as an agent to assist in healing of these lesions, and reduce ulcer-related bleeding.
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References
Jensen DM: Sclerosants for injection sclerosis of esophageal varices. Gastrointest Endosc 29:315–317, 1982. One of the few articles comparing sclerosants and mixtures of sclerosants in an animal model. From this article came the popular “Wadsworth solution,” a tetradecyl, alcohol, saline mixture.
Gimson A, Poison R, Westaby D, et al: Omeprazole in the management of intractable esophageal ulceration following injection sclerotherapy. Gastroenterology 99:1829–1831, 1990. Describes results of the use of omeprazole in ten cases with refractory injection-related ulceration. High-dose omeprazole (40 mg/day) healed ulcerations that had been refractory to high dose H2RAs and sucralfate.
Perino LE, Gholson CF, Goff JS: Esophageal perforation after fiberoptic variceal sclerotherapy. J Clin Gastroenterol 9:286–289, 1987. This article reports the authors’ experience with this particular complication of sclerotherapy and provides a review of the available literature.
Orlando RC: Cytoprotection by sucralfate in acid-exposed esophagus: A review. Scand J Gastroenterol 22(suppl 127):97–100,1987. A review of animal and clinical studies of the effects of sucralfate on esophageal mucosal protection.
Roark G: Treatment of postsclerotherapy esophageal ulcers with sucralfate. Gastrointest Endosc 30:9–10, 1984. The first report of apparent beneficial effects from the use of sucralfate for postinjection ulceration bleeding (an uncontrolled observation—but dramatic results).
Tabibian N, Smith JL, Graham DY: Sclerotherapy-associated esophageal ulcers: Lessons from a double-blind, randomized comparison of sucralfate suspension versus placebo. Gastrointest Endosc 35:312–315, 1989. The first randomized trial of sucralfate for injection-related ulceration. No clear effect found despite 78 versus 40% benefit for sucralfate in healing, as numbers were insufficient for significance.
Paquet KJ, Koussouris P, Keineth R, et al: A comparison of sucralfate with placebo in the treatment of esophageal ulcers following therapeutic endoscopic sclerotherapy of esophageal varices—a prospective randomized trial. Am J Med 91(2A):1478–1508, 1991. A large randomized trial showing faster healing for ulcerations in patients randomized to sucralfate, but no difference in the percent healed, as the patients randomized to sucralfate had significantly larger ulcerations.
Polson RJ, Westaby D, Gimson AE, et al: Sucralfate for the prevention of early rebleeding following injection sclerotherapy for esophageal varices. Hepatology 3:279–282, 1989. A large randomized trial showing reduced bleeding in the postinjection period, but the benefit was not seen in the decompensated patients, only those with reasonably well-compensated liver disease.
Steigmann G, Goff J, Michaletz-Onody P, et al: Endoscopic sclerotherapy as compared with endoscopic ligation for bleeding esophageal varices. N Engl J Med 326:1527–1532, 1992. A large randomized cooperative trial showing variceal ligation by endoscopic banding to be superior to variceal injection sclerotherapy with reduced complications and improved survival.
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© 1995 Plenum Press
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Brooks, W.S. (1995). Use of Sucralfate in Variceal Sclerotherapy-Induced Ulcerations. In: Hollander, D., Tytgat, G.N.J. (eds) Sucralfate. Springer, Boston, MA. https://doi.org/10.1007/978-0-585-32154-7_31
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DOI: https://doi.org/10.1007/978-0-585-32154-7_31
Publisher Name: Springer, Boston, MA
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