Outcomes of endoscopic sclerotherapy for jejunal varices at the site of choledochojejunostomy (with video): Three case reports

BACKGROUND

Hemorrhage associated with varices at the site of choledochojejunostomy is an unusual, difficult to treat, and often fatal manifestation of portal hypertension. So far, no treatment guidelines have been established.

CASE SUMMARY

We reported three patients with jejunal varices at the site of choledochojejunostomy managed by endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection at our institution between June 2021 and August 2023. We reviewed all patient records, clinical presentation, endoscopic findings and treatment, outcomes and follow-up. Three patients who underwent pancreaticoduodenectomy with a Whipple anastomosis were examined using conventional upper gastrointestinal endoscopy for suspected hemorrhage from the afferent jejunal loop. Varices with stigmata of recent hemorrhage or active hemorrhage were observed around the choledochojejunostomy site in all three patients. Endoscopic injection of lauromacrogol/α-butyl cyanoacrylate was carried out at jejunal varices for all three patients. The bleeding ceased and patency was observed for 26 and 2 months in two patients. In one patient with multiorgan failure and internal environment disturbance, rebleeding occurred 1 month after endoscopic sclerotherapy, and despite a second endoscopic sclerotherapy, repeated episodes of bleeding and multiorgan failure resulted in eventual death.

CONCLUSION

We conclude that endoscopic sclerotherapy with lauromacrogol/α-butyl cyanoacrylate injection can be an easy, effective, safe and low-cost treatment option for jejunal varicose bleeding at the site of choledochojejunostomy.

Value of fat-suppressed T2-weighted imaging for predicting short-term pain relief after sclerotherapy for venous malformations in the extremities

PURPOSE

This study aimed to evaluate the value of fat-suppressed T2-weighted imaging (FS-T2WI) for predicting short-term pain relief after polidocanol sclerotherapy for painful venous malformations (VMs) in the extremities.

MATERIALS AND METHODS

This retrospective study included patients with painful VMs in the extremities between October 2014 and September 2021, had their first sclerotherapy without history of surgical therapy, and underwent magnetic resonance imaging before sclerotherapy. Pain relief was assessed 2 months after 3% polidocanol sclerotherapy and was categorized as follows: progression, no change, partial relief, or free of pain. The associations between pain relief and imaging features on FS-T2WI were analyzed.

RESULTS

The study included 51 patients. The no change, partial relief, and free of pain groups included 6 (11.8%), 25 (49.0%), and 20 (39.2%) patients, respectively. No patient experienced progressive pain. The lesion diameter was ≤ 50 mm in 13 (65.0%) patients in the free of pain group, whereas it was > 50 mm in all patients in the no change group (p = 0.019). The lesions showed well-defined margin in 15 (75.0%) patients in the free of pain group, whereas they showed ill-defined margin in 5 (83.3%) patients in the no change group (p = 0.034). The most common morphological type was cavitary in the free of pain group (14 [70.0%] patients), whereas there was no patient with cavitary type lesion in the no change group (p = 0.003). Drainage vein was demonstrated in 6 (100%), 22 (88.0%), and 11 (55.0%) patients in the no change, partial relief, and free of pain group, respectively (p = 0.011).

CONCLUSION

A lesion size of 50 mm or less, a well-defined margin, a cavitary type, and no drainage vein on FS-T2WI were significant features for predicting short-term pain relief after polidocanol sclerotherapy for painful VMs in the extremities.

Foam Sclerotherapy in the Treatment of Hemangiomas and Venous Malformations

BACKGROUND

Sclerotherapy has achieved great success in treating most venous malformation (VM) lesions.

OBJECTIVE

To compare the effects of foam sclerotherapy on infantile hemangioma and pyogenic granuloma (PG). In addition, we analyzed the data and outcomes of foam sclerotherapy for the VM.

MATERIALS AND METHODS

Thirty-nine patients with hemangiomas and 83 patients with VMs were treated, and clinical outcomes, resolution, and complication rates were compared. Sclerotherapy data from the VM group were also analyzed.

RESULTS

The average age of the patients and the distribution and tissue involvement of lesions among the 3 groups were significantly different ( p < .001). The average amount of sclerosing foam administered per session in VMs was significantly higher than that in the other 2 groups ( p < .0001) (whereas that in the PG group was lower than that in the infantile hemangioma group [ p < .0001]). However, the overall therapeutic efficacy and side effects in the 3 groups were not significantly different. For VMs, the frequency of ultrasound guided foam sclerotherapy and use of 3% polidocanol increased from superficial to deep lesions, whereas the use of 1% POL decreased ( p < .0001).

CONCLUSION

Infantile hemangioma and PG treatments presented good results and minor adverse reactions comparable with those of VMs.

Effectiveness and safety of percutaneous sclerotherapy using absolute ethanol and/or polidocanol for maxillofacial venous malformations involving the masticatory muscles: A case series

OBJECTIVE

This study evaluated the effectiveness and safety of percutaneous sclerotherapy for maxillofacial venous malformations.

STUDY DESIGN

Patients who had venous malformations involving the masticatory muscles and who underwent sclerotherapy were enrolled in this retrospective study.

RESULTS

Twenty-four patients (13 female, 11 male; mean age 21 years) were analyzed. Major clinical symptoms were swelling (100%) and intralesional pain (54%). Intramuscular lesions involved the masseter muscle only in 38% of cases, both the masseter and temporalis muscles in 33%, all masticatory muscles in 21%, and the temporalis muscle only in 8%. Extramuscular involvement was observed in 58% of patients. Absolute ethanol and polidocanol were used as sclerosants. The mean number of sclerotherapy sessions per patient was 6.6 (range, 1-32). The mean follow-up duration after the first sclerotherapy session was 64.8 months (range, 6-178). The complications included paralysis of the facial nerve (25%), intraoral ulceration (8%), and hemoglobinuria (8%). The effectiveness of treatment was rated as excellent in 33% of cases, good in 46%, and fair in 21%. Better results were obtained in patients without extramuscular involvement.

CONCLUSION

Percutaneous sclerotherapy can be effective and safe for maxillofacial intramuscular venous malformations, especially for localized lesions of the masseter muscle.

3% polidocanol foam sclerotherapy versus hemorrhoidal artery ligation with recto anal repair in hemorrhoidal disease grades II-III: a randomized, pilot trial

PURPOSE

Polidocanol foam sclerotherapy (SP) versus doppler-guided hemorrhoidal artery ligation with recto-anal repair (HAL-RAR) in the treatment of hemorrhoidal disease (HD) was analyzed.

METHODS

A prospective, randomized study including patients with HD grades II and III was performed. Participants were randomly assigned (1:1) into SP or HAL-RAR, during a recruitment period between September 2019 and February 2020. Therapeutic success (Sodergren's and bleeding scores) was the primary outcome. Other outcomes evaluated included complications and implication in the professional life. Efficacy and safety outcomes were evaluated during the 8 weeks after surgery or the final SP session.

RESULTS

Forty-six patients were allocated either to SP (n=22) or HAL-RAR (n=24). Most patients achieved therapeutic success (SP 100% vs. HAL-RAR 90.9%, p=0.131). Complete success was higher in the SP group (91.7% vs. 68.2%, p=0.045) and SP patients had less complications (25% vs. 68.2%, p=0.003). HAL-RAR had a greater negative impact on work activity of the patient.

CONCLUSION

SP was more effective and safer than HAL-RAR. SP patients had less impact on their work activity. Clinical trials identifier NCT04675177.

Predictive factors analysis of cesarean scar pregnancy treated by local injection of Lauromacrogol combined with curettage

To explore factors related to local injection of Lauromacrogol combined with curettage in the treatment of cesarean scar pregnancy. A total of 24 successful and 8 unsuccessful cases were included. The age, gravidity, parity, times of cesarean section, interval from the last cesarean section, preoperative human chorionic gonadotropin (HCG), HCG on the first day after operation, decreasing rate of HCG on the first day after operation, average diameter of gestational sac, and preoperative vaginal bleeding days were analyzed. There were no significant differences of age, gravidity, parity, previous cesarean section times between groups. The differences of preoperative HCG, HCG on the first day after operation, the decreasing rate of HCG, gestational sac diameter, preoperative vaginal bleeding days were statistically significant between groups. The interval from the last cesarean section and the decreasing rate of HCG were protective factors, while the mean diameter of gestational sac and period of vaginal bleeding before operation were risk factors for the success of the treatment. The mean diameter of gestational sac owned the best predictive value.

Polidocanol: A Review of Off-Label Dermatologic Uses

BACKGROUND

Polidocanol is an FDA-approved treatment of incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system, but numerous other off-label dermatological applications have been reported.

OBJECTIVE

To describe the various off-label dermatological clinical uses of polidocanol, as well as efficacy and adverse effects.

METHODS

The review of studies searchable on PubMed from 2004 to 2021 describing clinical uses of polidocanol to determine efficacy and adverse effects associated with various dermatologic applications.

RESULTS

Polidocanol has shown efficacy in the treatment of mucocele of minor salivary gland, hemangioma, upper extremity veins, reticular veins of the chest, facial veins, pyogenic granuloma, lymphangioma circumscriptum, digital mucous cyst, mixed skin ulcers, cutaneous focal mucinosis, seromas, glomuvenous malformations, acne cysts, lymphocele, and dissecting cellulitis. Commonly reported side effects include pain, erythema, swelling, ecchymosis, and ulceration. Most sources were case reports and small prospective studies, as such the strength of data supporting many uses is limited by small sample sizes and lack of controls.

CONCLUSION

Although polidocanol is currently only FDA approved for incompetent great saphenous veins, accessory saphenous veins, and visible varicosities of the great saphenous vein system, the use of polidocanol has been selected for a variety of off-label clinical applications.

Polidocanol Foam Sclerotherapy Versus Rubber Band Ligation in Hemorrhoidal Disease Grades I/II/III: Randomized Trial

BACKGROUND

Rubber band ligation and sclerotherapy are considered the office-based procedures of choice in hemorrhoidal disease. However, there are no studies comparing rubber band ligation and polidocanol foam sclerotherapy.

OBJECTIVE

We aimed to evaluate the efficacy and safety of polidocanol foam sclerotherapy compared with rubber band ligation.

DESIGN

This study was a randomized open-label study with 1-year follow-up.

SETTINGS

The study was conducted in the colorectal unit of a tertiary hospital.

PATIENTS

One hundred twenty patients with hemorrhoidal disease grades I to III were included.

INTERVENTIONS

Patients were stratified by hemorrhoidal disease grade and randomly assigned (1:1) to treatment with either rubber band ligation (n = 60) or polidocanol foam sclerotherapy (n = 60).

MAIN OUTCOME MEASURES

Efficacy outcomes included therapeutic success and recurrence. Safety outcomes included the occurrence of complications related to the procedures.

RESULTS

Therapeutic success was not significantly different between the groups (polidocanol foam sclerotherapy 93.3% vs rubber band ligation 85.0%, p = 0.14). However, complete success rate was higher in the polidocanol foam sclerotherapy group (88.3% vs 66.7%, p = 0.009) with fewer office-based sessions (mean ± SD: 1.32 ± 0.60 vs 1.62 ± 0.76, p = 0.02). Recurrence rates were lower in the polidocanol foam sclerotherapy group (16.1% vs 41.2%, p = 0.004). Most recurrences were mild (83.3%). Complications were more frequent in the rubber band ligation group (30.0% vs 10.0%, p = 0.01) and were mostly minor (91.7%). No severe complications were observed in either group.

LIMITATIONS

This study was performed in a single center, and both patients and investigators were not blinded to the treatment group.

CONCLUSIONS

Both procedures are effective in the treatment of hemorrhoidal disease grades I to III. Polidocanol foam sclerotherapy was more effective than rubber band ligation when considering complete success. Patients in the polidocanol foam sclerotherapy group needed fewer treatment sessions, had lower recurrence rates, and were less likely to have complications. See Video Abstract at http://links.lww.com/DCR/B816.

REGISTRATION

https//www.clinicaltrials.gov; Identifier: NCT04091763.

ESCLEROTERAPIA CON ESPUMA DE POLIDOCANOL VERSUS LIGADURA CON BANDA DE GOMA EN LOS GRADOS I / II / III DE ENFERMEDAD HEMORROIDAL ENSAYO ALEATORIZADO

ANTECEDENTES:La ligadura con banda elástica y la escleroterapia se consideran los procedimientos de elección en el consultorio para la enfermedad hemorroidal. Sin embargo, no hay estudios que comparen la ligadura con bandas elastica y la escleroterapia con espuma de polidocanol.OBJETIVO:Nuestro objetivo fue evaluar la eficacia y seguridad de la escleroterapia con espuma de polidocanol en comparación con la ligadura con bandas elastica.DISEÑO:Estudio aleatorizado randomizado, abierto, con seguimiento de 1 año.AJUSTES:El estudio se realizó en una unidad colorrectal de un hospital terciario.PACIENTES:Se incluyeron 120 pacientes con enfermedad hemorroidal grados I a III.INTERVENCIONES:Los pacientes fueron estratificados por grado de enfermedad hemorroidal y asignados al azar (1: 1) al tratamiento con ligadura con banda elastica (n = 60) o escleroterapia con espuma de polidocanol (n = 60).PRINCIPALES MEDIDAS DE RESULTADO:Los resultados de eficacia incluyeron el éxito terapéutico y la recurrencia. Los resultados de seguridad incluyeron la aparición de complicaciones relacionadas con los procedimientos.RESULTADOS:El éxito terapéutico no fue significativamente diferente entre los grupos (escleroterapia con espuma de polidocanol 93,3% vs ligadura con banda de goma 85,0%, p = 0,14). Sin embargo, la tasa de éxito completo fue mayor en el grupo de escleroterapia con espuma de polidocanol (88,3% vs 66,7%, p = 0,009), con menos sesiones en el consultorio (media ± desviación estándar: 1,32 ± 0,60 vs 1,62 ± 0,76, p = 0,02). Las tasas de recurrencia fueron más bajas en el grupo de escleroterapia con espuma de polidocanol (16,1% vs 41,2%, p = 0,004). La mayoría de las recurrencias fueron leves (83,3%). Las complicaciones fueron más frecuentes en el grupo de ligadura con bandas elastica (30,0% vs 10,0%, p = 0,01) y fueron en su mayoría menores (91,7%). No se observaron complicaciones graves en ninguno de los grupos.LIMITACIONES:Este estudio se realizó en un solo centro y ni los pacientes ni los investigadores estaban cegados al grupo de tratamiento.CONCLUSIONES:Ambos procedimientos son efectivos en el tratamiento de la enfermedad hemorroidal grados I a III. La escleroterapia con espuma de polidocanol fue más eficaz que la ligadura con banda de goma cuando se consideró el éxito completo. Los pacientes del grupo de escleroterapia con espuma de polidocanol necesitaron menos sesiones de tratamiento, tuvieron tasas de recurrencia más bajas y menos probabilidades de tener complicaciones. Consulte Video Resumen en http://links.lww.com/DCR/B816. (Traducción-Dr Yolanda Colorado)ClinicalTrials.gov, número NCT04091763.

[Andean children with aneurysmal bone cyst treated with polidocanol (use off-label)]

INTRODUCTION

The aneurysmal bone cyst is a rare benign but aggressive osteolytic tumor for which there is still no ideal treatment, the reports on treatment by sclerotherapy in the pediatric population are scarce and in our region even less. The objective is to communicate the experience of the treatment of aneurysmal bone cyst with polydocanol 3%.

MATERIAL Y METHODS

Retrospective, descriptive and cross-sectional study. Period: June/2017 to June/2021. Inclusion: patients with histological diagnosis of aneurysmal bone cyst; Under general anesthesia and fluoroscopic guidance, intralesional puncture with 16G needle was performed through which 3% polydocanol was slowly administered. Data: medical history. Quantitative variables shall be expressed in measures of central tendency and dispersion; qualitative variables shall be expressed as frequencies or percentages.

RESULTS

Nine consecutive patients were included, all of whom had pain and tumor in one of the extremities. Gender: 3 female and 6 male. Age: median 10.5 years (range: 2-15.1). Weight: median 32.8 kg (range: 11-44.5). Total procedures: 44; procedures per patient: mean 4.9 (SD: ± 2.0). Procedure time: mean 33.9 minutes (SD: ± 18.3); radiation: mean 1.34 mGy (SD: ± 1.55). Hospitalization: one day, except one patient. Complications: skin damage in one case, no recurrences follow-up: 12 to 50 months.

CONCLUSION

In this pediatric series, polydocanol 3% was useful and effective for the treatment of aneurysmal bone cyst, with few complications. One disadvantage is that it requires several sessions and in addition, no significant difference has been demonstrated between other forms of treatment in terms of the recurrence rate.

Efficacy and safety of polidocanol in the treatment of varicose veins of lower extremities: A protocol for systematic review and meta-analysis

BACKGROUND

The varicose veins of the lower extremities showed earthworm-like dilatation and venous protrusion of the lower extremities. Polidocanol foam sclerotherapy, as a minimally invasive treatment with rapid recovery, less trauma and not easy to relapse, has achieved good results in clinical, but it is lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of polidocanol in the treatment of varicose veins of the lower extremities by meta-analysis.

METHOD

Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Scientifific Journals Database, China Biology Medicine disc, PubMed, EMBASE database, Web of Science, and Cochrane Library will be used as search sources to conduct for randomized controlled trials of polidocanol in the treatment of varicose veins of lower extremities. The search time is set from the establishment of the database in December 2020 in this study. Two researchers independently extract, delete files, extract data and evaluate the quality. Revman software version 5.3 will be used for statistical analysis of data.

RESULT

In this study, the efficacy and safety of polidocanol in the treatment of varicose veins of the lower extremities will be evaluated in terms of total effective rate, incidence of complications and recurrence rate.

CONCLUSION

This study will provide reliable evidence-based evidence for the clinical application of polidocanol in the treatment of varicose veins of lower extremities.

ETHICS AND DISSEMINATION

Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/AUR4X.

Development of Glycerol-Rose Bengal-Polidocanol (GRP) foam for enhanced sclerosis of a cyst for cystic diseases

Polycystic kidney disease (PKD) is a common genetic disorder that results in a proliferating and enlarging cyst and ultimately leads to loss of kidney function. Because an enlarged cyst is a primary factor for limited kidney function, the large cyst is surgically removed by laparoscopic deroofing or sclerosant. This a relatively nascent treatment method entails complications and sometimes fail due to the cyst fluid refilling and infection. This study proposes using a more stable and effective polidocanol foam with glycerol and Rose Bengal (GRP form) to prevent cyst regeneration and irritation, which is caused by the required body movement during the treatment. Specifically, the foam retention time and viscosity were increased by adding glycerol up to 10% (w/v). The GRP form inhibited cellular proliferation and disrupted cellular junctions, e-cadherin, and cyst formation, demonstrated by the LDH, Live and Dead, and re-plating culture assays. The GRP foam was shown to be a safe and effective treatment as a commercial grade polidocanol foam form by an in vivo study in which subcutaneously injected mice injected with commercial 3% polidocanol, and the GRP foam showed no difference in inflammation. Thus, this study provides an advanced polidocanol form by adding glycerol and Rose-Bengal to help existing sclerotherapy.

Successful Endoscopic Sclerotherapy Using Polidocanol for Small Bowel Hemangioma

Small-bowel hemangiomas are a possible source of gastrointestinal bleeding for which there is no established treatment approach. In this report, we describe the case of a 58-year-old woman who presented with hematochezia and who was diagnosed with small bowel hemangioma. She was successfully treated using endoscopic sclerotherapy. Initial capsule endoscopy revealed bleeding in the ileum. Subsequent double-balloon enteroscopy showed a 2-cm, bluish-purple, ileal submucosal tumor with an overlying protrusion. The lesion was responsible for the hematochezia and was treated with intralesional injection of polidocanol. The hematochezia completely resolved and at 4 months after sclerotherapy, the size of the lesion was significantly reduced.

Type II caesarean scar pregnancy management by ultrasound-guided local lauromacrogol injection in combination with suction curettage: A case report

INTRODUCTION

The implantation of a gestational sac within the scar of a previous caesarean delivery is defined as caesarean scar pregnancy (CSP), which is classified into two types: CSP I and CSP II. CSP II is life threatening, and no clear consensus for CSP II management exists.

PATIENT CONCERNS

A 31-year-old woman, gravida 1, para 1, with a previous caesarean delivery due to macrosomia, presented with an estimated 45 days of amenorrhea. The patient presented to the emergency department with vaginal bleeding for 1 day and no abdominal pain.

DIAGNOSES

An ultrasound examination was performed demonstrating a viable fetus that was embedded in the caesarean scar area and was bulging through the wall of the uterus into the bladder without contact with the uterine cavity or cervical canal. A diagnosis of type II caesarean scar pregnancy was made.

INTERVENTIONS

Local lauromacrogol was used to reduce the gestational sac blood supply. Suction curettage was performed under the guidance of abdominal ultrasound 24 h later, and the amount of bleeding was 20 mL. The response to the treatment was monitored by serial beta-human chorionic gonadotropin (β-hCG).

OUTCOMES

Patient was followed up with β-hCG weekly levels which became <10 mIU/mL after 4 weeks of treatment.

CONCLUSION

Ultrasound-guided local lauromacrogol injection combined with suction curettage may be a safer and novel therapeutic method.

Sandwich method with or without lauromacrogol in the treatment of gastric variceal bleeding with liver cirrhosis: A meta-analysis

BACKGROUND

To compare the efficacy and safety of the modified sandwich method with lauromacrogol in the treatment of gastric variceal bleeding (GVB) caused by liver cirrhosis with the traditional sandwich method no accompanied by lauromacrogol via a meta-analysis.

METHODS

The Cochrane Library, Pubmed, the China National Knowledge Infrastructure (CNKI) database, the Chinese Wanfang database, and the Chongqing VIP database were searched to identify cohort studies comparing modified to traditional sandwich method in the treatment of GVB with liver cirrhosis. The relative risk for hemostasis rate, gastric varices (GV) remission rate, re-bleeding rate, the incidence of post-operative complications (pain, fever, ulcer or erosion, ectopic embolism), and all-cause mortality were calculated. The mean difference for average tissue adhesive dosage per case was calculated. Relevant data were analyzed with the Reviewer Manager 5.3.5.

RESULTS

Four cohort studies with a total of 587 patients were included in this meta-analysis. In the treatment of GVB with liver cirrhosis, compared with the traditional sandwich method, the modified sandwich method was associated with a higher GV remission rate (RR: 1.24, 95% CI: 1.09-1.42; P = .001) according to the pooled results. There were no statistically significant differences between the 2 methods in the rate of hemostasis, re-bleeding, pain, fever, ulcer or erosion, ectopic embolism, and all-cause mortality (P ≧ .05).

CONCLUSIONS

This meta-analysis indicated that the modified sandwich method with lauromacrogol is more effective than the traditional sandwich method without lauromacrogol. Due to the limited number of studies and samples, more RCT studies are needed to further validate the efficacy and safety of the modified sandwich method with lauromacrogol in the treatment of GVB with liver cirrhosis.

Efficacy and safety of balloon-occluded retrograde transvenous obliteration of gastric varices with lauromacrogol foam sclerotherapy: initial experience

PURPOSE

Balloon-occluded retrograde transvenous obliteration (BRTO) is a widely-accepted treatment for gastric varices (GVs). The purpose of this study was to evaluate the efficacy and safety of BRTO with lauromacrogol foam sclerotherapy.

MATERIALS AND METHODS

Between May 2014 and June 2015, 32 patients were treated with lauromacrogol foam. Lauromacrogol foam was made using a combination of agents, with a 2:1:1 ratio of room air: lauromacrogol: contrast media. Patients were followed up using contrast-enhanced computed tomography (CT) and endoscopy.

RESULTS

Technical success was achieved in 31 of 32 patients (96.9%). Portal vein thrombosis occurred in two patients and resolved spontaneously. No other major complications were observed. The overall mean dose of lauromacrogol used was 12.4 mL (range, 8-20 mL). Complete obliteration of GVs was confirmed in all 31 patients (100%) on follow-up CT. Seven of the 31 patients (22.6%) experienced worsening of esophageal varices. Rupture of esophageal varices occurred in three patients and was treated successfully with band ligation. Five patients (16.1%) experienced worsening of ascites and responded well to diuretic therapy.

CONCLUSION

BRTO utilizing lauromacrogol foam appears to be a safe and useful treatment option in patients with GVs in the short term.