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Differences in hemostasis among sclerosing agents in endoscopic injection sclerotherapy

Digestive Diseases and Sciences volume 41, pages 562–570 (1996)Cite this article

Abstract

Endoscopic injection sclerotherapy is useful in stopping bleeding from esophageal varices. We compared thein vivo effects of sclerosants on thrombogenesis, hemostasis, and endothelial injury. We injected aethoxysclerol (AS) or ethanolamine oleate (EO) into the small veins of the rat intestine. The maximum thrombogenic index with AS was 30.7 and with EO was 9.2. The venous flow stopped sooner with EO than with AS. The thrombi caused by EO were mixed with red blood cells. Heparin pretreatment decreased the thrombogenic index with AS by 96.7%, but not that with EO. The area of the fluorescein-albumin conjugate that permeated from veins with AS was larger than that with EO. The fluorescent intensity with AS was lower than that with EO. We thus concluded that: (1) the size of thrombi is not necessarily proportional to the hemostatic efficacy; (2) changes in a patient's coagulation may affect the potential of sclerosants; (3) the excellent hemostatic efficacy of EO is based on localized injury to the endothelium and the involvement of red blood cells aggregation; and (4)in vivo microscopy is useful in determining the rational selection of sclerosants.

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Affiliations

  1. Institute of Clinical Research, National Saitama Hospital, Japan

    M. Tatemichi,  H. Nagata, E. Sekizuka, T. Morishita, M. Miyairi, M. Tsuchiya & H. Ishii

  2. Department of Internal Medicine, Shizuoka Red Cross Hospital, Japan

    M. Tatemichi,  H. Nagata, E. Sekizuka, T. Morishita, M. Miyairi, M. Tsuchiya & H. Ishii

  3. Department of Internal Medicine, School of Medicine, Keio University, Japan

    M. Tatemichi,  H. Nagata, E. Sekizuka, T. Morishita, M. Miyairi, M. Tsuchiya & H. Ishii

  4. Department of Internal Medicine, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, 108, Tokyo, Japan

    M. Tatemichi,  H. Nagata, E. Sekizuka, T. Morishita, M. Miyairi, M. Tsuchiya & H. Ishii

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  1. M. Tatemichi
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  2. H. Nagata
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  3. E. Sekizuka
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  4. T. Morishita
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  5. M. Miyairi
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  6. M. Tsuchiya
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  7. H. Ishii
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Tatemichi, M., Nagata, H., Sekizuka, E. et al. Differences in hemostasis among sclerosing agents in endoscopic injection sclerotherapy. Digest Dis Sci 41, 562–570 (1996). https://doi.org/10.1007/BF02282342

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  • DOI: https://doi.org/10.1007/BF02282342

Key words

  • sclerosant
  • thrombogenesis
  • hemostasis
  • in vivo microscopy
  • endoscopic injection sclerotherapy
  • vascular permeability