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Vol 4, No 2 (2011)
Research paper
Published online: 2011-07-07
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Effect of ethanolamine oleate and polidocanol on the respiratory function and blood count in patients treated with esophageal variceal sclerotherapy

Krzysztof Rusiniak, Andrzej B. Szczepanik
Journal of Transfusion Medicine 2011;4(2):82-98.

open access

Vol 4, No 2 (2011)
ORIGINAL PAPERS
Published online: 2011-07-07

Abstract


Background: The aim of the study was to perform the analysis of gasometric exchange in lungs following esophageal variceal sclerotherapy with 5% EO and 3% PC, determine the effect of enoxaparin on the gasometric changes in the lungs, on blood count as well as on the radiological image of the lungs in patients treated with 5% EO, evaluate the changes in the blood count and the radiological image of the lungs after ST and EVL and determine the type and frequency of complications following sclerotherapy procedure.
Material and methods: The study was conducted in four groups of 30 patients each: group I (EO) — ST with 5% EO, group II (PC) — ST with 3% PC, group III (EO + Enox) — endoxaparin was injected subcutaneously prior to ST with 5% EO and group IV (EVL) — EVL. Gasometric investigations of arterial and venous blood (pO2, pCO2 pH, satO2 ) were performed prior to each procedure as well as 1, 5, 15, 30, 60 and 120 min after. The following parameters were determined prior to procedure, in the 90 min and 24 hours after procedure; Ht, Hb, RBC, WBC, platelet count. Radiological examinations of the chest were performed prior to and 48 hours after procedure.
Results: Results for arterial blood: paO2, decrease was statistically significant in group I and II but the changes in group III and IV were not; paCO2 decreased to increase in groups I and III, increased in group II and decreased in group IV; pHa — increased in groups I and III, increased to decrease in goup II and no changes were observed in group IV; sataO2 decreased in groups I and II, and no significant changes were observed in groups III and IV.
Results for venous blood: pvO2, values showed no significant changes in groups I and II but an increase was observed in groups III and IV; pvCO2 increased in group I, decreased in group II and IV and decreased to increase in group III; pHv — values increased in group I , II and III and no changes were observed in group IV; satvO2 — decreased in groups I and increased in groups II, III and IV. Blood parameters (Ht, Hb, RBC, WBC, platelet count) significantly decreased in 90. min following procedure in all four groups. After 24 h no statistically significant changes in blood parameters were observed as compared to initial values. Radiological changes in the lungs — pleural reactions were observed in 4 patients from group I, in 6 from II, in 3 from III and 3 from IV. Inflammatory reactions were reported in 2 patients from group I, in 2 from II, in one from III and IV.
Conclusions:
1. Esophageal variceal sclerotherapy with 5% EO and 3% PC causes gasometric changes in arterial and venous blood manifested as decrease of pO2 and SatO2 as well as increase of pCO2 and pH.
2. Disturbances of gasometric exchange in lungs are transient and cause no clinical symptoms.
3. Injections of enoxaparin prior to ST with 5% EO prevent such changes in gasometric parameters.
4. Blood count increased in 90 minutes after ST and EVL with no changes in clinical state of patients.
5. ST with 5% EO and 3% PC is the cause of radiological changes in the lungs manifested as exudative pleuritis and atelectatic changes.
6. Symptoms observed after ST such as retrosternal pain, subfebrile body temperature, transient fever and nausea, are regarded rather as ST-associated symptoms than real complications.
J. Transf. Med. 2011; 2: 82–98

Abstract


Background: The aim of the study was to perform the analysis of gasometric exchange in lungs following esophageal variceal sclerotherapy with 5% EO and 3% PC, determine the effect of enoxaparin on the gasometric changes in the lungs, on blood count as well as on the radiological image of the lungs in patients treated with 5% EO, evaluate the changes in the blood count and the radiological image of the lungs after ST and EVL and determine the type and frequency of complications following sclerotherapy procedure.
Material and methods: The study was conducted in four groups of 30 patients each: group I (EO) — ST with 5% EO, group II (PC) — ST with 3% PC, group III (EO + Enox) — endoxaparin was injected subcutaneously prior to ST with 5% EO and group IV (EVL) — EVL. Gasometric investigations of arterial and venous blood (pO2, pCO2 pH, satO2 ) were performed prior to each procedure as well as 1, 5, 15, 30, 60 and 120 min after. The following parameters were determined prior to procedure, in the 90 min and 24 hours after procedure; Ht, Hb, RBC, WBC, platelet count. Radiological examinations of the chest were performed prior to and 48 hours after procedure.
Results: Results for arterial blood: paO2, decrease was statistically significant in group I and II but the changes in group III and IV were not; paCO2 decreased to increase in groups I and III, increased in group II and decreased in group IV; pHa — increased in groups I and III, increased to decrease in goup II and no changes were observed in group IV; sataO2 decreased in groups I and II, and no significant changes were observed in groups III and IV.
Results for venous blood: pvO2, values showed no significant changes in groups I and II but an increase was observed in groups III and IV; pvCO2 increased in group I, decreased in group II and IV and decreased to increase in group III; pHv — values increased in group I , II and III and no changes were observed in group IV; satvO2 — decreased in groups I and increased in groups II, III and IV. Blood parameters (Ht, Hb, RBC, WBC, platelet count) significantly decreased in 90. min following procedure in all four groups. After 24 h no statistically significant changes in blood parameters were observed as compared to initial values. Radiological changes in the lungs — pleural reactions were observed in 4 patients from group I, in 6 from II, in 3 from III and 3 from IV. Inflammatory reactions were reported in 2 patients from group I, in 2 from II, in one from III and IV.
Conclusions:
1. Esophageal variceal sclerotherapy with 5% EO and 3% PC causes gasometric changes in arterial and venous blood manifested as decrease of pO2 and SatO2 as well as increase of pCO2 and pH.
2. Disturbances of gasometric exchange in lungs are transient and cause no clinical symptoms.
3. Injections of enoxaparin prior to ST with 5% EO prevent such changes in gasometric parameters.
4. Blood count increased in 90 minutes after ST and EVL with no changes in clinical state of patients.
5. ST with 5% EO and 3% PC is the cause of radiological changes in the lungs manifested as exudative pleuritis and atelectatic changes.
6. Symptoms observed after ST such as retrosternal pain, subfebrile body temperature, transient fever and nausea, are regarded rather as ST-associated symptoms than real complications.
J. Transf. Med. 2011; 2: 82–98
Get Citation

Keywords

esophageal varices; sclerotherapy; gasometric; morphological; radiological changes; enoxaparin; complications

About this article
Title

Effect of ethanolamine oleate and polidocanol on the respiratory function and blood count in patients treated with esophageal variceal sclerotherapy

Journal

Journal of Transfusion Medicine

Issue

Vol 4, No 2 (2011)

Article type

Research paper

Pages

82-98

Published online

2011-07-07

Bibliographic record

Journal of Transfusion Medicine 2011;4(2):82-98.

Keywords

esophageal varices
sclerotherapy
gasometric
morphological
radiological changes
enoxaparin
complications

Authors

Krzysztof Rusiniak
Andrzej B. Szczepanik

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