Objective To evaluate the efficacy and safety of endoscopic variceal ligation (EVL) versus endoscopic variceal sclerotherapy (EVS) for acute esophageal variceal bleeding in patients with liver cirrhosis.Methods We searched CBMdisc (1979 to 2006), CNKI (1994 to 2006) and VIP for randomized controlled trials (RCTs) and quasi-RCTs comparing EVL and EVS for acute esophageal variceal bleeding patients with liver cirrhosis. The methodogical quality of included trials was critically assessed and the data were extracted by two reviewers, working independently. The Cochrane Collaboration’s RevMan 4.2.7 software was used for meta-analysis. Results Nine RCTs involving a total of 1371 patients were included: 688 in EVL group and 683 in EVS. The meta-analyses showed a significant reduction for mortality [RR 0.60, 95%CI (0.36, 0.98)], and non-significant reductions in complications, rebleeding and emergency hemostasis in the EVL group compared to the EVS group. EVS was non-significantly better than EVL for the rate of eradication varices and recurrent varices. Conclusions For acute esophageal variceal bleeding in patients with liver cirrhosis, EVL has better effect and fewer complications than EVS. However, because the quality of included RCTs was poor, the strength of our conclusions was limited. Further high-quality RCTs are required.
From September 1988 to May 1985, 67 cases of thyroid cysts were treated with aspiration and ethanol injection. Patients were followed up clinically and ultrasonically 6 month to 4 years after treatment. Cure was defined as complete disappealance of the cyst or presence of a residual fibrotic mass less than 1 cm in diameter, effectiveness was defined as the residual mass less than 50% of the original one. After one to three injections, 27 out of 36 patients of thyroid adnoma with cystic change (75 %)were cured, the effective rate was 88.2%. The cure rate of nodular goiter with cystic change was 50%(14 out of 28 cases, while the effective rate was 82%.No serious complication occurred in this series. During the period of following up, no malignant change was found. The results suggest that aspiration of thyroid cyst with ethanol injection is a simple, well tolerated and low cost technique.
Objective To compare the effect of high ligation and spot stripping (HLSS) and high ligation and foam sclerotherapy (HLFS) in the treatment of great saphenous varicose veins (GSVV). Methods A retrospective analysis was conducted on the clinical data of 385 patients with GSVV who received HLFS or HLSS treatment at Guizhou Provincial People’s Hospital from January 2018 to June 2022. The differences in surgical time, intraoperative bleeding, complications, and postoperative hospital stay between the two groups were compared. Results The surgical time, intraoperative bleeding, postoperative hospital stay, visual analog scale for pain, incidence of postoperative hematoma, skin sensory disorders, and infection in the HLFS group were less or lower than those in the HLSS group (P<0.05), but there was no statistically significant difference in recurrence rate between the two groups (P>0.05). Compared with preoperative indicators at the same group, the modified venous clinical severity score (VCSS) decreased and the chronic lower limb venous insufficiency questionnaire (CIVIQ) score increased (P<0.05). However, there was no statistically significant difference in the degree of improvement in VCSS and CIVIQ between the two groups at three months after surgery and before surgery (P>0.05). Conclusions HLFS has a definite therapeutic effect on GSVV, with smaller trauma, faster recovery after surgery, and lower incidence of postoperative complication compared to HLSS. It can be used as a surgical option for GSVV patients in clinical practice.
Objective To study efficacy of ligation and stripping of great saphenous vein in combination with foam sclerotherapy and foam sclerotherapy alone in treatment of venous leg ulcer. Method Fifty-seven patients with venous leg ulcers from January 2015 to December 2016 in the West China Hospital of Sichuan University were collected, then were designed to ligation and stripping of great saphenous vein in combination with foam sclerotherapy group (abbreviated as combination therapy group, n=33) and foam sclerotherapy alone group (n=24). Results The baseline data such as the age, gender, disease duration, and ulcer size had no significant differences in these two groups (P>0.05). All the patients received operation successfully. The median operative time was shorter, the average intraoperative blood loss was less, and the time of ulcer healing after surgery was longer in the foam sclerotherapy alone group as compared with the combination therapy group [14 minversus 40 min, P<0.001; (12.3±3.2) mLversus (35.5±10.0) mL, P<0.001; (22.0±4.5) dversus (13.7±4.0) d, P<0.001]. The rates of the wound infection, local pigmentation, and ulcer recurrence had no significant differences between the foam sclerotherapy alone group and the combination therapy group (4.2%versus 9.1%, P=0.472; 25.0% versus 15.2%, P=0.352; 20.8% versus 9.1%, P=0.208). The foam sclerotherapy alone group was obviously superior to the combination therapy group in the time and cost of hospitalization (4 d versus 13 d, P<0.001; 3 000 yuanversus 8 590 yuan, P<0.001). There was no large area of tissue necrosis, the deep vein thrombosis, or the other serious complications in these two groups. Conclusion Ligation and stripping of great saphenous vein in combination with foam sclerotherapy in treatment of venous leg ulcer can accelerate ulcer healing than foam sclerotherapy alone, but there is no significant difference between these two groups in complications and recurrence rate, the foam sclerotherapy alone group is superior in time and cost of hospitalization, appropriate treatment plan should be formulated according to specific situation of patient.
ObjectiveTo evaluate the clinical efficacy of polidocanol foam sclerotherapy and to establish a reliable evidence base for its application in the treatment of hemorrhoids. MethodsA systematic literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, Chongqing VIP, and the Chinese Medical Journal Full-text Database for randomized controlled trials published from January 1, 2000 to December 1, 2024. Included patients were assigned to either an intervention group group (treated with polidocanol foam sclerotherapy) or a control group (receiving other interventions). Data from the included studies were pooled and analyzed using a meta-analysis model in Review Manager (RevMan) software, version 5.4. The primary outcomes were the clinical cure rate, postoperative recurrence rate, and incidence of postoperative bleeding. The secondary outcomes were the pain visual analogue scale (VAS) score and the incidence of severe postoperative pain. ResultsA total of 12 RCTs involving 1 380 patients with hemorrhoids were included. The pooled results demonstrated that, compared to the control group, the intervention group showed a significantly higher clinical cure rate [RR(95%CI)=1.36(1.26, 1.47)], as well as lower postoperative recurrence rate [RR(95%CI)=0.43 (0.29, 0.65)] and postoperative bleeding rate [RR(95%CI)=0.75(0.60, 0.93)]. However, there were no statistically significant differences between the groups in terms of postoperative pain VAS score [WMD(95%CI) =–0.53(–1.15, 0.09)] or the incidence of severe postoperative pain [RR(95%CI)=0.81(0.34, 1.94)]. ConclusionsPolidocanol foam sclerotherapy demonstrates superior clinical efficacy in terms of clinical cure rate, postoperative recurrence rate, and postoperative bleeding rate, confirming its effectiveness as a treatment for hemorrhoids.