The outcome of suspected upper gastrointestinal bleeding with 24-hour access to upper gastrointestinal endoscopy: a prospective cohort study

BACKGROUND AND STUDY AIM: The aim was to evaluate the 30-day mortality after endoscopy for suspected upper gastrointestinal bleed, following the implementation of national audit guidelines at our hospital. PATIENTS AND METHODS: All patients with suspected upper gastrointestinal bleeding, referred for endoscopy to our teaching hospital between October 2001 and December 2003, were included in a prospective cohort study. RESULTS: A total of 716 patients with suspected upper gastrointestinal tract haemorrhage were referred for urgent endoscopy. The median age was 69 years (interquartile range 51 - 80 years). Bleeding from peptic ulcer remained the single most common endoscopic diagnosis (40 %). The overall re-bleeding rate for all patients with a gastrointestinal haemorrhage was 10 %. The overall 30-day mortality rate was 14.6 %. This was not significantly different from the mortality rate in 1995 of 10.5 % ( P = 0.11). Patients who died were significantly older (78 vs. 67 years, 95 %CI of the difference 5 to 12, P < 0.001). However, in only 29 % (30/105) was gastrointestinal haemorrhage stated in the death certificate as a factor which contributed to their death. CONCLUSIONS: Our results show that implementing the good practice guideline has a limited impact on overall mortality because of contributing factors that are beyond the control of clinicians.     

Nonsurgical control of upper gastrointestinal hemorrhage in old age patients: Intragastric norepinephrine and endoscopic alcoholization of lesions

Of 28 consecutive patients over 64 years old, in whom endoscopy revealed gastro-duodenal ulcers with signs of recent hemorrhage (active bleeding, nonbleeding vessel or adherent clot), 14 were randomly assigned to receive endoscopic alcoholization of the lesions preceded by intragastric instillation of norepinephrine, while as controls 14 received antacids. After the applied treatment the bleeding stopped in all cases (100%) in the study group and one patient died (7.1%) after hemostasis was achieved. In the control group bleeding stopped in 12 patients (85.7%). Two patients continued to bleed and needed emergency surgery. Another patient had a major rebleed successfully treated by alcoholization. There were 4 deaths (28%): 2 patients died postoperatively and the other 2 from acute porphyria and bronchopneumonia respectively. The transfusion requirements after the entry into trial were significantly lower in the study group compared to controls (mean no. of blood units 0.79 vs. 1.71). No complications were seen with the treatment applied. These results suggest that endoscopic alcoholization of the lesions preceded by intragastric instillation of norepinephrine is an effective and safe emergency therapy for bleeding from peptic ulcers in old age patients.     

Acute upper gastrointestinal haemorrhage in patients aged 80 years or more

We report a series of 103 admissions of patients aged 80 years or more with acute upper gastrointestinal haemorrhage to one hospital over a four-year period. A cause was eventually found during 81.5 per cent of admissions and of these, 57 per cent had bled from chronic peptic ulcers. After 64 per cent of admissions, the patient received a blood transfusion and in 25 per cent, the blood transfusion exceeded 5 units. Nine patients had surgery for peptic ulcer during admission but no operations were performed in patients with other causes of upper gastrointestinal haemorrhage. Patients with peptic ulcer, when compared to patients with other causes for haemorrhage, were more likely to have symptoms of upper gastrointestinal disease before presentation. They were also more likely to continue to bleed, to bleed again, to require surgery, and to die as a consequence of haemorrhage. Eighteen admissions (17.5 per cent) ended with death but in only 11 (10.5 per cent) did the patient die directly because of haemorrhage. Nine of these bled from a peptic ulcer, one from oesophageal varices and one from an unknown cause. Patients who died from haemorrhage, when compared to all others, were more likely to have bled from a peptic ulcer and to have significant co-existing disease, to have ingested non-steroidal antiinflammatory drugs or aspirin before admission, to have raised blood urea level and low systolic blood pressure at admission and to have required blood transfusion of more than 5 units. Our study has shown that upper gastrointestinal haemorrhage secondary to peptic ulceration is a serious and often fatal condition in the elderly. Identification and effective monitoring of those at particular risk of death may be essential if mortality is to be reduced.     

Ectopic variceal bleeding from chronic superior mesenteric vein thrombosis after hemorrhagic pancreatitis

Varices are a common cause of gastrointestinal (GI) bleed. When ectopic, there is often a delay in diagnosis as it is difficult to localize these varices. Ectopic small bowel varices usually arise from portal hypertension, which commonly develops in the setting of cirrhosis. This case presents a much rarer cause of bleeding ectopic varices with portal hypertension secondary to chronic superior mesenteric vein (SMV) thrombosis that developed after an episode of hemorrhagic pancreatitis. An 81‐year‐old man with a past medical history of a recent GI bleeds secondary to an arteriovenous malformation presented to the hospital with continued melena after a recent admission at another hospital for the same symptom. Upper endoscopy and colonoscopy showed no evidence of active bleeding. Subsequently computed tomography angiography (CTA) showed bleeding from collaterals in the third part of the duodenum, consistent with ectopic varices. The CTA also showed SMV thrombosis. The patient underwent an ultrasound‐guided transhepatic venogram with coiling and sclerosant embolization of SMV varices and distal SMV balloon angioplasty. Capsule endoscopy after showed no evidence of further bleeding. The patient was discharged 72 h after the intervention with stabilized hemoglobin and resolved melena. Ectopic varices should be on the differential diagnosis for patients presenting with a GI bleed that remains nonlocalized after endoscopy and colonoscopy. EGD or colonoscopy is the first‐line intervention for the treatment of bleeding ectopic varices. If unreachable by these means, percutaneous coil embolization is an alternative way to stabilize the patient. As no general management guidelines exist, treatment of bleeding ectopic varices should continue to be case‐dependent and involve a multidisciplinary team.     

Characterization of gastrointestinal bleeding in severely ill hospitalized patients

OBJECTIVE: To characterize the source of bleeding and the prognosis in critically ill patients with upper gastrointestinal hemorrhage that developed while in the hospital. SETTING: Intensive care units of a large academic tertiary-care center. DESIGN: Retrospective cohort study. SUBJECTS: Patients undergoing endoscopy in intensive care units for gastrointestinal bleeding that developed while in the hospital. MEASUREMENTS AND MAIN RESULTS: Medical records were available for 142 patients. Of these, 66 met the criteria for in-hospital bleeding. Peptic ulcer disease, present in 56% of patients, was the most common bleeding source identified. Of patients with peptic ulcer disease, nine of 37 (24%) had stigmata of recent hemorrhage. Ten patients (15%) received endoscopic hemostasis interventions (eight receiving therapy for bleeding ulcers, two receiving therapy for esophageal varices). The in-hospital mortality rate was 42%. The cause of death was sepsis and/or multiple system organ failure in 21 patients (75%); the gastrointestinal bleeding may have contributed to the onset of sepsis in one of these patients. No patients died directly of gastrointestinal bleeding. CONCLUSIONS: Critically ill patients who bleed while in the hospital have similar sources of bleeding and rates of endoscopically directed therapy as patients admitted to hospital with bleeding. The mortality rate is very high in patients with bleeding that develops in the hospital, and this is usually a result of systemic disease. These data may help clinicians and patients to estimate the potential benefit of urgent endoscopy in critically ill patients.     

Overlooked lesions at emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding

BACKGROUND AND STUDY AIMS: Excessive blood covering the examination field is a frequent cause of diagnostic failure in emergency endoscopy for acute upper gastrointestinal bleeding. The implications and outcome in these patients have not been well described. PATIENTS AND METHODS: The records for 1459 consecutive patients who presented at our medical center with acute nonvariceal upper gastrointestinal bleeding during a 15-month period were reviewed. All of the patients underwent emergency endoscopy within 24 h of initial presentation. Patients in whom an identifiable bleeding source was not found in spite of an overtly bloody lumen were designated as having a failure of diagnosis, and these cases were analyzed further. RESULTS: Diagnosis failed in 25 patients (1.7 %), 16 of whom underwent repeat endoscopy or surgical intervention. Bleeding vessels were identified in 13 of these patients. Gastric and duodenal ulcers were the most commonly overlooked lesions, with locations in the cardia (n = 3), fundus (n = 2), posterior wall of the antrum (n = 1), duodenal bulb (n = 3), second part of the duodenum (n = 2), and in the stoma of a Billroth II gastrectomy (n = 2). The rates for endoscopic complications, recurrent bleeding, surgery, and mortality were significantly higher in the group with diagnostic failure than in patients with acute upper gastrointestinal bleeding in whom diagnosis did not fail (8 % vs. 0.4 %; 20 % vs. 3.1 %; 16 % vs. 2.9 %; and 20 % vs. 3.6 %, respectively). CONCLUSIONS: In acute nonvariceal upper gastrointestinal bleeding, diagnostic failure is associated with higher morbidity and mortality. The data from this study emphasize the importance of good preparation before the procedure and adequate removal of blood during emergency endoscopy procedures.     

Significance of emergency endoscopy in severe upper gastrointestinal hemorrhage

312 of a total of 543 emergency endoscopies were carried out in patients with severe haemorrhage of the upper gastrointestinal tract. This was defined as a haemorrhage of such severity that at least 2 of the following 3 criteria were present: a shock index greater than 1, an erythrocyte count of less than 3 million/mm3, and a transfusion requirement of three or more 500 ml bags of blood. The source of the bleeding was exactly located in 247 endoscopies, and accurate diagnoses were established in 94.4% of the cases examined. The most frequent source of bleeding was oesophageal varices, followed by duodenal ulcers. In 20.2% of these cases, further sources of potential haemorrhage were found in the upper gastrointestinal tract. Endoscopic diagnosis resulted in immediate, specific therapy in 286 cases. Treatment was given within the first 24 hours in every case. 24.7% of our patients had to undergo laparotomy immediately after endoscopy. 30.4% were given H2 receptor inhibitors, and 35.6% underwent endoscopic haemostasis. The mortality rate in these patients was 29.5%. These results indicate that emergency endoscopy is an important aid to decision-making in cases of severe haemorrhage of the upper gastrointestinal tract.     

Causes and clinical outcome of acute upper gastrointestinal bleeding: a prospective analysis of 1534 cases

Despite considerable improvement in the diagnostic and therapeutic approach to patients with acute upper gastrointestinal (GI) bleeding, several studies suggest there has been no overall change in mortality. The aim of this study was to evaluate prospectively the effect of early emergency diagnostic and therapeutic endoscopy and medico-surgical collaboration in the clinical outcome of 1534 patients with acute upper GI bleeding treated in our hospital over the past five years. Emergency endoscopy and injection haemostasis were performed within 24 hours of admission, or immediately after resuscitation, in patients with massive bleeding; patients were then treated with close co-operation between surgeons and gastroenterologists. We observed an increase in the incidence of peptic ulcer (67%) with a simultaneous decrease in the incidence of gastroduodenitis (13.5%) as a cause of bleeding compared with the previous decade. In peptic ulcer bleeding, emergency surgical haemostasis was required in 92 patients (8.9%), while none of the patients with erosive gastroduodenitis required surgical intervention. Overall mortality was 2.9%, and in peptic ulcer bleeding patients 2.1% with a postsurgical mortality of 8.7%. Peptic ulcer remains the main cause of upper GI bleeding. Improved clinical outcome and low mortality can be achieved with early diagnostic and therapeutic endoscopy and medico-surgical collaboration.     

Clinical manifestations and outcomes of severe warfarin overanticoagulation: from the EWA study

Introduction: Severe warfarin overanticoagulation is a risk factor for bleeding, but there is little information on its manifestations, prognosis and factors affecting the outcome. We describe the manifestations and clinical outcomes of severe warfarin overanticoagulation in a large group of patients with atrial fibrillation (AF).

Material and methods: All international normalized ratio (INR) samples (n?=?961,431) in the Turku University Hospital region between 2003 and 2015 were screened. A total of 412?AF patients with INR ≥9 were compared to 405 patients with stable warfarin anticoagulation for AF. Electronic patient records were manually reviewed to collect comprehensive data.

Results: Of the 412 patients with INR ≥9, bleeding was the primary manifestation in 105 (25.5%). Non-bleeding symptoms were recorded in 165 (40.0%) patients and 142 (34.5%) had no symptoms. A total of 17 (16.2%) patients with a bleed and 67 (21.8%) without bleeding died within 30 days after the event. Intracranial haemorrhage strongly predicted death within 30 days. Other significant predictors were non-bleeding symptoms, active malignancies, recent bleed, history of myocardial infarction, older age, renal dysfunction and a recent treatment episode.

Conclusions: Bleeds are not the major determinant of the poor prognosis in severe overanticoagulation, as coincidental INR ≥9 findings also associate with high mortality.

• KEY MESSAGES

• Only a quarter of AF patients with INR ≥9 suffered a bleeding event and the clinical manifestation of INR ≥9 had a significant impact on patient outcome.

• The 30-day mortality rate in patients with INR ≥9 was high ranging from 9.2 to 32.7%.

• Several significant predictors of 30-day mortality after INR ≥9 were identified.

     

Acute Upper Gastrointestinal Haemorrhage in Patients Aged 80 Years or More

We report a series of 103 admissions of patients aged 80 yearsor more with acute upper gastrointestinal haemorrhage to onehospital over a four-year period. A cause was eventually foundduring 81.5 per cent of admissions and of these, 57 per centhad bled from chronic peptic ulcers. After 64 per cent of admissions,the patient received a blood transfusion and in 25 per cent,the blood transfusion exceeded 5 units. Nine patients had surgeryfor peptic ulcer during admission but no operations were performedin patients with other causes of upper gastrointestinal haemorrhage.Patients with peptic ulcer, when compared to patients with othercauses for haemorrhage, were more likely to have symptoms ofupper gastrointestinal disease before presentation. They werealso more likely to continue to bleed, to bleed again, to requiresurgery, and to die as a consequence of haemorrhage. Eighteenadmissions (17.5 per cent) ended with death but in only 11 (10.5per cent) did the patient die directly because of haemorrhage.Nine of these bled from a peptic ulcer, one from oesophagealvarices and one from an unknown cause. Patients who died fromhaemorrhage, when compared to all others, were more likely tohave bled from a peptic ulcer and to have significant co-existingdisease, to have ingested non-steroidal anti-inflammatory drugsor aspirin before admission, to have raised blood urea leveland low systolic blood pressure at admission and to have requiredblood transfusion of more than 5 units. Our study has shownthat upper gastrointestinal haemorrhage secondary to pepticulceration is a serious and often fatal condition in the elderly.Identification and effective monitoring of those at particularrisk of death may be essential if mortality is to be reduced.     

Prediction of mortality at endoscopy in bleeding peptic ulcer disease

One hundred and forty two patients with bleeding peptic ulcers underwent emergency endoscopy. Seventy six had endoscopic stigmata of haemorrhage and nine subsequently died. There were no deaths amongst sixty six patients without stigmata (p less than 0.02). Patients with stigmata were also significantly more likely to experience further bleeding (p less than 0.001) and to require emergency operations (p less than 0.01). Excess risk attached to those with bleeding at the time of endoscopy and those with visible vessels or clot adherent to the ulcer but not to patients with staining of the ulcer base. Patients without stigmata or with staining alone should be managed conservatively. Clinical trials in bleeding peptic ulcer disease should only include patients in the high risk group.     

Esophageal visible vessel as a cause of massive upper gastrointestinal hemorrhage

Besides peptic ulcers, erosions, esophageal varices, tumors and non-variceal esophageal lesions, vascular abnormalities lead to an upper gastrointestinal hemorrhage in 1-5% of cases. Among 581 emergency esophagogastro-duodenoscopies for acute gastrointestinal bleeding performed in our institution between 1987 and 1989, an esophageal visible vessel was found to be the source of massive hemorrhage in five patients. All patients were males with ages ranging from 37 to 84 years. Esophageal visible vessel was localized in one patient in the middle third and in four patients in the distal portion of the esophagus. Using the Forrest classification, endoscopy revealed an oozing hemorrhage (Ib) in two patients and a protruding vessel (IIa) in three patients. Definitive hemostasis could be achieved in all patients by local injection of adrenaline combined with heater probe thermocoagulation. In some patients with recurrent upper gastrointestinal bleeding, visible esophageal vessel is a rare source of bleeding that has not yet been described.     

Predictors of peptic ulcer rebleeding after scheduled second endoscopy: clinical or endoscopic factors?

BACKGROUND AND STUDY AIMS: In a previous study we demonstrated the efficacy of second-look endoscopy with therapy within 16 - 24 hours after index endoscopy in reducing major recurrent peptic ulcer bleeding. In this study, we sought to identify factors that might predict further rebleeding after this scheduled second-look endoscopy. PATIENTS AND METHODS: We studied 249 patients (181 men, 68 women) with acute bleeding peptic ulcers who were treated at the United Christian Hospital, Hong Kong from 1999 to 2002 and who underwent a scheduled second endoscopy. Those patients who developed rebleeding after the second endoscopy were evaluated, and possible predictive factors for rebleeding were analyzed using a logistic regression model. RESULTS: Of the 249 patients who underwent scheduled second-look endoscopy, 17 patients (6.8 %) developed rebleeding: seven of these patients were treated by another endoscopic therapy; ten patients required surgery. The overall mortality rate was 3.1 %. A logistic regression analysis performed on the possible predictive factors for rebleeding found that the following factors were associated with a significant risk of further rebleeding after scheduled second endoscopy: American Society of Anesthesiologists (ASA) grade III or grade IV status (odds ratio 3.81, 95 % CI 1.27 - 11.44), ulcer size greater than 1.0 cm (odds ratio 4.69, 95 % CI 1.60 - 13.80), and a finding of persistent stigmata of recent hemorrhage at the scheduled second endoscopy (odds ratio 6.65, 95 % CI 2.11 - 20.98). CONCLUSIONS: Endoscopic factors, including large ulcer size and the persistence of endoscopic stigmata of recent hemorrhage are important predictors for recurrent bleeding after scheduled second endoscopy.     

α-氰丙烯酸烷基酯栓塞治疗胃静脉曲张破裂出血的临床观察

目的评价经内镜注射组织黏合剂α-氰丙烯酸烷基酯栓塞治疗胃静脉曲张的临床疗效及不良反应。方法 18例临床确诊的肝硬化合并急性胃静脉曲张破裂出血的患者中,活动出血5例,近期出血13例,胃静脉曲张Sarin分类胃食管静脉曲张Ⅰ型（GOV1）7例,胃食管静脉曲张Ⅱ型（GOV2）8例,孤立性胃静脉曲张Ⅰ型（IGV1）7例,在静脉滴注奥曲肽的同时,经内镜首先选择靶静脉及穿刺点,根据曲张静脉的直径确定组织黏合剂的剂量,依次对胃曲张静脉采用三明治法进行组织黏合剂栓塞治疗,11例合并食管静脉曲张的患者在栓塞治疗后联合食管曲张静脉套扎治疗,术后进行内镜随访,观察止血成功率、早期再出血率、病死率、静脉曲张消退情况以及不良反应。结果急诊止血成功率100%,早期再出血率0%、静脉曲张消退显效13例（72.2%）,有效3例（16.7%）,无效2例（11.1%）;3例出现术后低热,1例出现大肠杆菌败血症;11例注射部位出现糜烂,4例注射部位形成溃疡;1例术中出血。结论经内镜注射组织黏合剂α-氰丙烯酸烷基酯栓塞治疗胃静脉曲张破裂出血是一种简便、安全、有效的方法。     

Is early endoscopy in the emergency room beneficial in patients with bleeding peptic ulcer? A "fortuitously controlled" study

BACKGROUND AND STUDY AIMS: In previous randomized trials, early endoscopy improved the outcome in patients with bleeding peptic ulcer, though most of these studies defined "early" as endoscopy performed within 24 hours after admission. Using the length of hospital stay as the primary criterion for the clinical outcome, we compared the results of endoscopy done immediately after admission (early endoscopy in the emergency room, EEE) with endoscopy postponed to a time within the first 24 hours after hospitalization, but still during normal working hours ("delayed" endoscopy in the endoscopy unit, DEU). PATIENTS AND METHODS: We conducted a retrospective analysis of data from 81 consecutive patients with bleeding peptic ulcer admitted in 1997 and 1998 (age range 16 - 90 years). Of these 81 patients, 38 underwent DEU (the standard therapy at the hospital) and 43 underwent EEE. Patients in the two groups were comparable with regard to admission criteria, were equally distributed with respect to their risk of adverse outcome (assessed using the Baylor bleeding score and the Rockall score), and differed only in the treatment they received. Endoscopic hemostasis was performed whenever possible in all patients with Forrest types I, IIa, and IIb ulcer bleeding. RESULTS: We found similar rates in the two groups for recurrent bleeding (16 % in DEU patients vs. 14 % in EEE patients), persistent bleeding (8 % in DEU patients vs. none in EEE patients), medical complications (21 % in DEU patients vs. 26 % in EEE patients), the need for surgery (8 % in DEU patients vs. 9 % in EEE patients), and the length of hospital stay (5.1 days for DEU patients vs. 5.9 days for EEE patients). None of the differences between the two groups in these parameters were statistically significant. None of the patients died. CONCLUSIONS: Early endoscopy in an emergency room did not improve the clinical outcome in our 81 consecutive patients with bleeding peptic ulcer.     

聚桂醇和血凝酶局部注射联合密集套扎治疗肝硬化伴食管静脉曲张破裂出血的临床研究

目的 探讨聚桂醇和血凝酶局部注射并联合密集套扎法治疗肝硬化伴食管静脉曲张破裂出血(EVB)的临床疗效.方法 选取2016年2月-2019年12月在该科住院的肝硬化伴EVB患者45例,随机分为两组.对照组(n=21)采用密集套扎治疗,治疗组(n=24)在密集套扎治疗的基础上,再在每两个结扎点曲张静脉内注射混合液(聚桂醇1...     

Diagnosis, therapy and sequelae of upper gastrointestinal haemorrhage in acute pancreatis]

Gastrointestinal bleeding complicating pancreatitis is a grave development which carries a high mortality rate. Ten out of 450 patients treated by us for pancreatitis developed gastrointestinal haemorrhage; 7 of these patients died, 6 of whom had a haemorrhagic necrotic, and one a so-called oedematous form of pancreatitis as diagnosed at autopsy. Nine operations were performed, most of them being only drainage procedures. Persistent shock or recurrence of severe symptoms with constant chemical pathological changes in the course of acute pancreatitis call for the rapid initiation of an aggressive approach towards diagnosis (endoscopy, angiography) and therapy, with radical surgical procedures, as indicated, aimed at rectifying the extensive pathology. We believe that these are the only possible means of achieving a reduction in the extremely high mortality rate in these cases and of avoiding late complications such as pseudocysts with the inherent danger of bleeding, abscesses and portal hypertension.     

Life-threatening intraabdominal arterial embolization after histoacryl injection for bleeding gastric ulcer

N-butyl-cyanoacrylate (Histoacryl) injection has become the treatment of choice for acutely bleeding esophagogastric varices, and is the only effective option for endoscopic treatment of gastric varices. Recent reports confirm the ability of Histoacryl injection therapy to achieve immediate hemostasis in cases of gastric ulcer bleeding or Dieulafoy ulcer, where conventional endoscopic hemostatic treatment had failed. Although the overall safety record of Histoacryl injection has been relatively good, there have been scattered cases of serious complications. Here, we present two patients showing life-threatening intraabdominal arterial embolization after Histoacryl injection. They had chronic gastric ulcers with active arterial bleeding. In spite of attempts at hemostatic treatment, complete hemostasis was not achieved. We injected Histoacryl, diluted with Lipiodol, into bleeding gastric ulcers, resulting in successful hemostasis. Soon after the procedure, intraabdominal arterial embolization developed in both patients. One patient survived and the other died. Based on these experiences, we would like to warn gastrointestinal endoscopists to be alert to these fatal complications, and we propose that less diluted Histoacryl seems to be preferable in cases of bleeding peptic ulcers.     

Endoscopic sclerotherapy: the value of balloon tamponade and the importance of disinfection

Endoscopic sclerotherapy in active variceal bleeding stopped bleeding in 48 out of 67 patients (72%). Survival of the acute bleeding episode was related to liver function: 6% mortality in Child A patients vs. 48% mortality in Child C. Comparing two treatment modalities: 24 h Linton balloon tamponade followed by sclerotherapy vs. sclerotherapy alone, our results in comparable groups slightly, although not significantly, favor tamponade-sclerotherapy treatment: 75% survival vs. 71%. As this treatment modality is more convenient and helps to avoid dangerous aspiration pneumonia, we advocate balloon tamponade prior to sclerotherapy in acute variceal bleeding. In maintenance treatment 65 patients were treated until eradication of varices. The rebleeding risk was 0.034% per patient per month, with 64% of the rebleeding within the 2 first months before complete eradication of the varices. The long-term survival depends largely on liver function: one year survival of 88% in Child A vs. 30% in Child C. Using Aethoxysklerol 1% in intravariceal injection, no stricture occurred. Using a sterile injection needle and a glutaraldehyde-disinfected endoscope, no infectious complications directly related to the procedure occurred, and all hemocultures remained negative.