Gastrointestinal varices historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Historical Perspective
Landmark Events In The Development Of Treatment Strategies
Pre-1970s
- In 1939, Crafoord and Freckner discovered sclerotherapy with the help of quinine for the management of oesophageal varices
- In the 20th century, sclerotherapy became an important treatment option in the management of variceal haemorrhage, especially with the advent of fibre-optic endoscopy
- Prior to the 1970s, surgery was the mainstay of therapy for variceal haemorrhage
- Previously, surgical techniques such as oesophageal stapling or oesophagectomy were used, but with high mortality rates from complications such as sepsis, liver failure and renal failure
- In the 1980s, in patients with portal hypertension, devascularisation procedures were associated with decreased mortality in patients
- In the late 20th century, splenectomy became a famous procedure for management of gastrointestinal varices
- Surgical therapies are employed in patients who have failed endoscopic procedures
- In 1950, The Sengstaken-Blakemore tube’s use was first described by Sengstaken and Blakemore and later used as a treatment option in 1930
- It has been largely replaced by endoscopic therapies
1970s and 1980s
- In the early 1970s, the first reported case series of endoscopic sclerotherapywas published with its use becoming more widespread in the 1980s
- Ethanolamine oleate, sodium tetradecyl sulphate, polidocanol, sodium morrhuate and ethanol have been used as treatment options in sclerotherapy
- In Europe the most commonly used agents were ethanolamine oleate and polidocanol, whereas in the United States sodium morrhuate was employed as a treatment strategy
- Paravariceal injection consisted of injection in the vicinity of the varix causing variceal occlusion by tamponade resulting in submucosal fibrosis of tissue around the varix, on the other hand, intra-variceal injection lead to thrombosis and resultant occlusion of the lumen
- Sclerotherapy when compared to placebo and baloon tamponade has been shown to significantly control bleeding from varices
- In 1988, EVBL was first used for the treatment of esophageal varices, based on the concept of banding haemorrhoids with elastic O-rings. EVBL became a treatment option for the treatment of esophageal varices in 1990s
1990s
- In the 1990s, sclerotherapy became a popular treatment option not only for esophageal varices but gastric varices as well
- EVBL became increasingly popular treatment modality for esophageal varices in the 1990s
- To achieve higher success rates in endoscopic therapies, pharmacological therapies for example, the use of octreotide, telipressin and somatostatin was developed for better control of variceal hemorrhage