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Is endoscopic paravascular injection of sclerosing agents reasonable in the control of GI bleeding?

Abstract：

BACKGROUND:The pharmacologic response and microvascular effects associated with the endoscopic injection of sclerosing agents around vessels (paravascular injection) to stop bleeding from the digestive tract remain to be clarified. METHODS:Using in vivo microscopy, we directly visualized submucosal microvessels of the rat stomach and intestine. We studied differences among sclerosing agents in thrombus formation and vascular diameter change that occur through a pharmacologic response and/or local compression after topical application or paravascular injection of the agents. RESULTS:Except for absolute ethanol, topical application of the agents did not cause constriction or thrombi in either arterioles or venules. Polidocanol topical application and paravascular injection significantly dilated arterioles. Injecting ethanolamine oleate near venules constricted them the longest and most effectively, but vasoconstriction in arterioles was transient. Injecting absolute ethanol formed long-lasting thrombi and caused vasoconstriction in venules, but arteriole thrombi persisted no more than 3 minutes. The vascular response to thrombin did not significantly differ from that to physiologic saline. CONCLUSION:The paravascular injection of ethanolamine oleate, because of its long-lasting vasoconstriction, or of absolute ethanol, because of its thrombogenic effect, is a valid therapeutic approach to treating venous bleeding. The efficacy of paravascular injection of sclerosing agents for treating acute arterial bleeding, however, is not supported in this experimental model.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Tatemichi M,Nagata H,Sekizuka E,Morishita T,Mizuki A,Ishii H

doi

10.1016/s0016-5107(99)70072-6

keywords:

subject

Has Abstract

pub_date

1999-10-01 00:00:00

pages

499-505

issue

4

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(99)70072-6

journal_volume

50

pub_type

杂志文章

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